41921f1580da148447557f7df77f161e jouclimed_a2022v11n10p2695.pdf 2b8bb3eded3458e7ec436306325367243c2c067e jouclimed_a2022v11n10p2695.pdf c861ca49e566c98a8423804cebab428caec8cf6c824913a7826c596bd61f1aab jouclimed_a2022v11n10p2695.pdf Title: Anticoagulant Treatment in Severe ARDS COVID-19 Patients Subject: Patients with COVID-19 may complicate their evolution with thromboembolic events. Incidence of thromboembolic complications are high and also, patients with the critically-ill disease showed evidence of microthrombi and microangiopathy in the lung probably due to endothelial damage by directly and indirectly injured endothelial and epithelial cells. Pulmonary embolism, deep venous thrombosis and arterial embolism were reported in patients with COVID-19, and several analytical abnormal coagulation parameters have been described as well. D-dimer, longer coagulation times and lower platelet counts have been associated with poor outcomes. The use of anticoagulation or high doses of prophylactic heparin is controversial. Despite the use of anticoagulation or high prophylactic dose of heparin have been associated with better outcomes in observational studies, only in patients with non-critically ill disease benefits for anticoagulation was observed. In critically-ill patient, anticoagulation was not associated with better outcomes. Other measures such as antiplatelet therapy, fibrinolytic therapy or nebulized anticoagulants are being studied in ongoing clinical trials. Keywords: COVID-19; heparin; nebulization; inflammation; coagulation Author: Adrian Ceccato, Marta Camprubí-Rimblas, Elena Campaña-Duel, Aina Areny-Balagueró, Luis Morales-Quinteros and Antonio Artigas Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Wed May 11 03:54:27 2022 CEST ModDate: Wed May 11 05:35:22 2022 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 10 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 2778034 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- YWWVQQ+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 OHKNFJ+VnURWPalladioL Type 1 Custom yes yes no 15 0 YGDIXZ+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 JGVZRW+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 XFCWAV+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 46 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 49 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-05-30 02:32:19 CEST RepresentationInformation: jouclimed_a2022v11n10p2695.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2022-05-17 12:02:16 CEST Size: 2778034 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 298 FreeObjects: 5 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Pathophysiology Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Item: Title: Thrombotic Events Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Anticoagulant Treatment Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Other Antithrombotic Treatments Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Nebulized Anti-Coagulants Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Recommended Management Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Info: Title: Anticoagulant Treatment in Severe ARDS COVID-19 Patients Author: Adrian Ceccato, Marta Camprubí-Rimblas, Elena Campaña-Duel, Aina Areny-Balagueró, Luis Morales-Quinteros and Antonio Artigas Subject: Patients with COVID-19 may complicate their evolution with thromboembolic events. Incidence of thromboembolic complications are high and also, patients with the critically-ill disease showed evidence of microthrombi and microangiopathy in the lung probably due to endothelial damage by directly and indirectly injured endothelial and epithelial cells. Pulmonary embolism, deep venous thrombosis and arterial embolism were reported in patients with COVID-19, and several analytical abnormal coagulation parameters have been described as well. D-dimer, longer coagulation times and lower platelet counts have been associated with poor outcomes. The use of anticoagulation or high doses of prophylactic heparin is controversial. Despite the use of anticoagulation or high prophylactic dose of heparin have been associated with better outcomes in observational studies, only in patients with non-critically ill disease benefits for anticoagulation was observed. In critically-ill patient, anticoagulation was not associated with better outcomes. Other measures such as antiplatelet therapy, fibrinolytic therapy or nebulized anticoagulants are being studied in ongoing clinical trials. Keywords: COVID-19; heparin; nebulization; inflammation; coagulation Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Wed May 11 03:54:27 CEST 2022 ModDate: Wed May 11 05:35:22 CEST 2022 ID: 0x0f414c0955363eb1b9d14c8ad0aea206, 0x0f414c0955363eb1b9d14c8ad0aea206 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: YGDIXZ+URWPalladioL-Bold FontSubset: true FirstChar: 2 LastChar: 241 FontDescriptor: FontName: YGDIXZ+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: JGVZRW+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 243 FontDescriptor: FontName: JGVZRW+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: YWWVQQ+VnURWPalladioL-Bold FontSubset: true FirstChar: 189 LastChar: 226 FontDescriptor: FontName: YWWVQQ+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: XFCWAV+URWPalladioL-Ital FontSubset: true FirstChar: 46 LastChar: 119 FontDescriptor: FontName: XFCWAV+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: OHKNFJ+VnURWPalladioL FontSubset: true FirstChar: 129 LastChar: 226 FontDescriptor: FontName: OHKNFJ+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 99, 335, 152, 344 Annotation: Subtype: Link Rect: 34, 323, 128, 332 Annotation: Subtype: Link Rect: 34, 164, 96, 186 Annotation: Subtype: Link Rect: 126, 90, 154, 99 Annotation: Subtype: Link Rect: 34, 78, 147, 87 Annotation: Subtype: Link Rect: 34, 756, 176, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 280, 679, 291, 693 Annotation: Subtype: Link Rect: 285, 667, 296, 680 Annotation: Subtype: Link Rect: 344, 227, 351, 236 ActionDest: 99 Annotation: Subtype: Link Rect: 242, 151, 249, 160 ActionDest: 99 Annotation: Subtype: Link Rect: 189, 126, 196, 135 ActionDest: 99 Annotation: Subtype: Link Rect: 321, 114, 328, 122 ActionDest: 99 Annotation: Subtype: Link Rect: 528, 101, 535, 110 ActionDest: 99 Annotation: Subtype: Link Rect: 184, 76, 191, 85 ActionDest: 99 Annotation: Subtype: Link Rect: 130, 17, 267, 28 Annotation: Subtype: Link Rect: 424, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 420, 87, 439 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 534, 648, 541, 657 ActionDest: 99 Annotation: Subtype: Link Rect: 541, 648, 548, 657 ActionDest: 99 Annotation: Subtype: Link Rect: 549, 647, 556, 657 ActionDest: 99 Annotation: Subtype: Link Rect: 549, 610, 556, 619 ActionDest: 99 Annotation: Subtype: Link Rect: 202, 572, 209, 581 ActionDest: 99 Annotation: Subtype: Link Rect: 209, 572, 221, 581 ActionDest: 99 Annotation: Subtype: Link Rect: 377, 497, 384, 506 ActionDest: 99 Annotation: Subtype: Link Rect: 422, 494, 429, 506 ActionDest: 68 Annotation: Subtype: Link Rect: 249, 174, 256, 183 ActionDest: 99 Annotation: Subtype: Link Rect: 242, 99, 254, 108 ActionDest: 99 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 378, 710, 390, 719 ActionDest: 99 Annotation: Subtype: Link Rect: 229, 647, 241, 657 ActionDest: 102 Annotation: Subtype: Link Rect: 225, 597, 237, 606 ActionDest: 102 Annotation: Subtype: Link Rect: 392, 585, 404, 594 ActionDest: 102 Annotation: Subtype: Link Rect: 390, 547, 402, 556 ActionDest: 102 Annotation: Subtype: Link Rect: 244, 522, 256, 531 ActionDest: 102 Annotation: Subtype: Link Rect: 239, 509, 251, 519 ActionDest: 102 Annotation: Subtype: Link Rect: 204, 459, 216, 468 ActionDest: 102 Annotation: Subtype: Link Rect: 382, 434, 394, 443 ActionDest: 102 Annotation: Subtype: Link Rect: 394, 434, 406, 443 ActionDest: 102 Annotation: Subtype: Link Rect: 528, 422, 540, 431 ActionDest: 102 Annotation: Subtype: Link Rect: 297, 384, 309, 393 ActionDest: 102 Annotation: Subtype: Link Rect: 523, 359, 535, 368 ActionDest: 102 Annotation: Subtype: Link Rect: 194, 334, 206, 343 ActionDest: 102 Annotation: Subtype: Link Rect: 357, 309, 369, 318 ActionDest: 102 Annotation: Subtype: Link Rect: 370, 309, 382, 318 ActionDest: 102 Annotation: Subtype: Link Rect: 233, 284, 245, 293 ActionDest: 102 Annotation: Subtype: Link Rect: 329, 195, 341, 204 ActionDest: 102 Annotation: Subtype: Link Rect: 264, 170, 276, 179 ActionDest: 102 Annotation: Subtype: Link Rect: 277, 170, 289, 179 ActionDest: 102 Annotation: Subtype: Link Rect: 262, 158, 274, 167 ActionDest: 102 Annotation: Subtype: Link Rect: 325, 95, 337, 104 ActionDest: 102 Annotation: Subtype: Link Rect: 337, 95, 349, 104 ActionDest: 102 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 520, 735, 532, 744 ActionDest: 102 Annotation: Subtype: Link Rect: 282, 685, 293, 694 ActionDest: 102 Annotation: Subtype: Link Rect: 252, 647, 264, 657 ActionDest: 102 Annotation: Subtype: Link Rect: 349, 622, 361, 631 ActionDest: 105 Annotation: Subtype: Link Rect: 369, 422, 381, 431 ActionDest: 105 Annotation: Subtype: Link Rect: 302, 396, 314, 406 ActionDest: 105 Annotation: Subtype: Link Rect: 401, 309, 413, 318 ActionDest: 105 Annotation: Subtype: Link Rect: 413, 309, 425, 318 ActionDest: 105 Annotation: Subtype: Link Rect: 441, 120, 453, 129 ActionDest: 105 Annotation: Subtype: Link Rect: 206, 83, 218, 92 ActionDest: 105 Annotation: Subtype: Link Rect: 221, 83, 232, 92 ActionDest: 105 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 195, 723, 207, 732 ActionDest: 105 Annotation: Subtype: Link Rect: 332, 710, 344, 719 ActionDest: 105 Annotation: Subtype: Link Rect: 526, 698, 538, 707 ActionDest: 105 Annotation: Subtype: Link Rect: 194, 620, 201, 631 ActionDest: 85 Annotation: Subtype: Link Rect: 544, 432, 556, 441 ActionDest: 105 Annotation: Subtype: Link Rect: 519, 394, 531, 403 ActionDest: 105 Annotation: Subtype: Link Rect: 544, 357, 556, 366 ActionDest: 105 Annotation: Subtype: Link Rect: 483, 331, 495, 341 ActionDest: 105 Annotation: Subtype: Link Rect: 258, 143, 270, 152 ActionDest: 105 Annotation: Subtype: Link Rect: 271, 143, 283, 152 ActionDest: 105 Annotation: Subtype: Link Rect: 438, 130, 450, 139 ActionDest: 105 Annotation: Subtype: Link Rect: 219, 93, 231, 102 ActionDest: 105 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 270, 723, 282, 732 ActionDest: 105 Annotation: Subtype: Link Rect: 545, 710, 557, 719 ActionDest: 105 Annotation: Subtype: Link Rect: 505, 698, 517, 707 ActionDest: 108 Annotation: Subtype: Link Rect: 517, 698, 529, 707 ActionDest: 108 Annotation: Subtype: Link Rect: 256, 673, 268, 682 ActionDest: 108 Annotation: Subtype: Link Rect: 185, 635, 197, 644 ActionDest: 108 Annotation: Subtype: Link Rect: 198, 635, 210, 644 ActionDest: 108 Annotation: Subtype: Link Rect: 535, 572, 542, 581 ActionDest: 99 Annotation: Subtype: Link Rect: 302, 497, 314, 506 ActionDest: 108 Annotation: Subtype: Link Rect: 517, 484, 529, 493 ActionDest: 108 Annotation: Subtype: Link Rect: 532, 484, 544, 493 ActionDest: 108 Annotation: Subtype: Link Rect: 305, 371, 317, 380 ActionDest: 108 Annotation: Subtype: Link Rect: 499, 343, 506, 355 ActionDest: 88 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 355, 381, 392, 392 Annotation: Subtype: Link Rect: 398, 381, 435, 392 Annotation: Subtype: Link Rect: 109, 359, 146, 369 Annotation: Subtype: Link Rect: 152, 359, 188, 369 Annotation: Subtype: Link Rect: 441, 346, 478, 357 Annotation: Subtype: Link Rect: 485, 346, 521, 357 Annotation: Subtype: Link Rect: 496, 324, 533, 334 Annotation: Subtype: Link Rect: 113, 289, 151, 300 Annotation: Subtype: Link Rect: 157, 289, 193, 300 Annotation: Subtype: Link Rect: 206, 255, 244, 265 Annotation: Subtype: Link Rect: 250, 255, 286, 265 Annotation: Subtype: Link Rect: 113, 220, 151, 231 Annotation: Subtype: Link Rect: 135, 186, 173, 196 Annotation: Subtype: Link Rect: 135, 163, 172, 173 Annotation: Subtype: Link Rect: 376, 139, 413, 150 Annotation: Subtype: Link Rect: 135, 105, 172, 116 Annotation: Subtype: Link Rect: 178, 105, 214, 116 Annotation: Subtype: Link Rect: 118, 71, 155, 81 Annotation: Subtype: Link Rect: 161, 71, 197, 81 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 153, 711, 191, 721 Annotation: Subtype: Link Rect: 197, 711, 233, 721 Annotation: Subtype: Link Rect: 143, 676, 181, 687 Annotation: Subtype: Link Rect: 520, 652, 557, 664 Annotation: Subtype: Link Rect: 255, 618, 292, 629 Annotation: Subtype: Link Rect: 213, 583, 250, 594 Annotation: Subtype: Link Rect: 140, 550, 177, 560 Annotation: Subtype: Link Rect: 309, 526, 346, 537 Annotation: Subtype: Link Rect: 307, 491, 345, 502 Annotation: Subtype: Link Rect: 140, 458, 177, 468 Annotation: Subtype: Link Rect: 183, 458, 219, 468 Annotation: Subtype: Link Rect: 284, 434, 322, 445 Annotation: Subtype: Link Rect: 328, 434, 364, 445 Annotation: Subtype: Link Rect: 277, 400, 314, 410 Annotation: Subtype: Link Rect: 320, 400, 356, 410 Annotation: Subtype: Link Rect: 520, 376, 557, 387 Annotation: Subtype: Link Rect: 59, 366, 95, 376 Annotation: Subtype: Link Rect: 269, 342, 307, 353 Annotation: Subtype: Link Rect: 288, 319, 326, 330 Annotation: Subtype: Link Rect: 188, 284, 226, 295 Annotation: Subtype: Link Rect: 242, 261, 560, 272 Annotation: Subtype: Link Rect: 175, 250, 213, 261 Annotation: Subtype: Link Rect: 230, 227, 268, 238 Annotation: Subtype: Link Rect: 400, 215, 437, 226 Annotation: Subtype: Link Rect: 298, 192, 335, 203 Annotation: Subtype: Link Rect: 341, 192, 377, 203 Annotation: Subtype: Link Rect: 252, 169, 290, 180 Annotation: Subtype: Link Rect: 296, 169, 332, 180 Annotation: Subtype: Link Rect: 364, 135, 402, 146 Annotation: Subtype: Link Rect: 273, 101, 311, 111 Annotation: Subtype: Link Rect: 317, 101, 353, 111 Annotation: Subtype: Link Rect: 477, 77, 515, 88 Annotation: Subtype: Link Rect: 521, 77, 557, 88 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 122, 665, 159, 675 Annotation: Subtype: Link Rect: 105, 619, 142, 629 Annotation: Subtype: Link Rect: 349, 595, 386, 606 Annotation: Subtype: Link Rect: 364, 572, 402, 583 Annotation: Subtype: Link Rect: 234, 527, 272, 537 Annotation: Subtype: Link Rect: 160, 491, 401, 502 Annotation: Subtype: Link Rect: 520, 491, 557, 502 Annotation: Subtype: Link Rect: 59, 481, 95, 491 Annotation: Subtype: Link Rect: 158, 446, 196, 456 Annotation: Subtype: Link Rect: 202, 446, 238, 456 Annotation: Subtype: Link Rect: 174, 399, 212, 410 Annotation: Subtype: Link Rect: 218, 399, 254, 410 Annotation: Subtype: Link Rect: 311, 376, 348, 387 Annotation: Subtype: Link Rect: 327, 342, 364, 353 Annotation: Subtype: Link Rect: 420, 307, 457, 318 Annotation: Subtype: Link Rect: 374, 273, 411, 284 Annotation: Subtype: Link Rect: 59, 251, 96, 261 Annotation: Subtype: Link Rect: 275, 227, 313, 238 Annotation: Subtype: Link Rect: 467, 204, 505, 215 Annotation: Subtype: Link Rect: 511, 204, 547, 215 Annotation: Subtype: Link Rect: 440, 169, 477, 180 Annotation: Subtype: Link Rect: 378, 135, 415, 146 Annotation: Subtype: Link Rect: 422, 135, 458, 146 Annotation: Subtype: Link Rect: 82, 101, 119, 111 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 59, 699, 96, 710 Annotation: Subtype: Link Rect: 520, 676, 557, 687 Annotation: Subtype: Link Rect: 520, 652, 557, 664 Annotation: Subtype: Link Rect: 168, 619, 205, 629 Annotation: Subtype: Link Rect: 214, 584, 252, 594 Annotation: Subtype: Link Rect: 281, 549, 319, 560 Annotation: Subtype: Link Rect: 380, 503, 418, 514 Annotation: Subtype: Link Rect: 183, 458, 221, 468 Annotation: Subtype: Link Rect: 227, 458, 263, 468 Annotation: Subtype: Link Rect: 256, 412, 292, 422 Annotation: Subtype: Link Rect: 59, 366, 96, 376 Checksum: 0b8d5a5c Type: CRC32 Checksum: 41921f1580da148447557f7df77f161e Type: MD5 Checksum: 2b8bb3eded3458e7ec436306325367243c2c067e Type: SHA-1