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BMC Pregnancy and Childbirth Aug 2021Currently, we suffer from an increasing diabetes pandemic and on the other hand from the SARS-CoV-2 pandemic. Already at the beginning of the SARS-CoV-2 pandemic, it was...
BACKGROUND
Currently, we suffer from an increasing diabetes pandemic and on the other hand from the SARS-CoV-2 pandemic. Already at the beginning of the SARS-CoV-2 pandemic, it was quickly assumed that certain groups are at increased risk to suffer from a severe course of COVID-19. There are serious concerns regarding potential adverse effects on maternal, fetal, and neonatal outcomes. Diabetic pregnancies clearly need special care, but clinical implications as well as the complex interplay of diabetes and SARS-CoV-2 are currently unknown. We summarized the evidence on SARS-CoV-2 in diabetic pregnancies, including the identification of novel potential pathophysiological mechanisms and interactions as well as clinical outcomes and features, screening, and management approaches.
METHODS
We carried out a systematic scoping review in MEDLINE (PubMed), EMBASE, CINAHL, Cochrane Library, and Web of Science Core Collection in September 2020.
RESULTS
We found that the prognosis of pregnant women with diabetes mellitus and COVID-19 may be associated with potential underlying mechanisms such as a simplified viral uptake by ACE2, a higher basal value of pro-inflammatory cytokines, being hypoxemic as well as platelet activation, embolism, and preeclampsia. In the context of "trans-generational programming" and COVID-19, life-long consequences may be "programmed" during gestation by pro-inflammation, hypoxia, over- or under-expression of transporters and enzymes, and epigenetic modifications based on changes in the intra-uterine milieu. COVID-19 may cause new onset diabetes mellitus, and that vertical transmission from mother to baby might be possible.
CONCLUSIONS
Given the challenges in clinical management, the complex interplay between COVID-19 and diabetic pregnancies, evidence-based recommendations are urgently needed. Digital medicine is a future-oriented and effective approach in the context of clinical diabetes management. We anticipate our review to be a starting point to understand and analyze mechanisms and epidemiology to most effectively treat women with SARS-COV-2 and diabetes in pregnancy.
Topics: COVID-19; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Maternal Health; Pregnancy; Pregnancy Complications, Infectious; Pregnancy in Diabetics; Prenatal Care; Primary Prevention
PubMed: 34416856
DOI: 10.1186/s12884-021-03975-3 -
International Journal of Molecular... Jul 2021In severe COVID-19, which is characterized by blood clots and neutrophil-platelet aggregates in the circulating blood and different tissues, an increased incidence of...
In severe COVID-19, which is characterized by blood clots and neutrophil-platelet aggregates in the circulating blood and different tissues, an increased incidence of cardiovascular complications and venous thrombotic events has been reported. The inflammatory storm that characterizes severe infections may act as a driver capable of profoundly disrupting the complex interplay between platelets, endothelium, and leukocytes, thus contributing to the definition of COVID-19-associated coagulopathy. In this frame, P-selectin represents a key molecule expressed on endothelial cells and on activated platelets, and contributes to endothelial activation, leucocyte recruitment, rolling, and tissue migration. Briefly, we describe the current state of knowledge about P-selectin involvement in COVID-19 pathogenesis, its possible use as a severity marker and as a target for host-directed therapeutic intervention.
Topics: Blood Coagulation Disorders; Blood Platelets; COVID-19; Endothelial Cells; Humans; Leukocytes; P-Selectin
PubMed: 34360707
DOI: 10.3390/ijms22157942 -
Seminars in Thrombosis and Hemostasis Apr 2022Mortality after aneurysmal subarachnoid hemorrhage (aSAH) is augmented by rebleeding and delayed cerebral ischemia (DCI). A range of assays evaluating the dynamic...
Mortality after aneurysmal subarachnoid hemorrhage (aSAH) is augmented by rebleeding and delayed cerebral ischemia (DCI). A range of assays evaluating the dynamic process of blood coagulation, from activation of clotting factors to fibrinolysis, has emerged and a comprehensive review of hemostasis and fibrinolysis following aSAH may reveal targets of treatment. We conducted a systematic review of existing literature assessing coagulation and fibrinolysis following aSAH, but prior to treatment. PubMed, Embase, and Web of Science were searched on November 18, 2020, without time boundaries. In total, 45 original studies were eventually incorporated into this systematic review, divided into studies presenting data only from conventional or quantitative assays ( = 22) and studies employing dynamic assays ( = 23). Data from conventional or quantitative assays indicated increased platelet activation, whereas dynamic assays detected platelet dysfunction possibly related to an increased risk of rebleeding. Secondary hemostasis was activated in conventional, quantitative, and dynamic assays and this was related to poor neurological outcome and mortality. Studies systematically investigating fibrinolysis were sparse. Measurements from conventional or quantitative assays, as well as dynamic fibrinolysis assays, revealed conflicting results with normal or increased lysis and changes were not associated with outcome. In conclusion, dynamic assays were able to detect reduced platelet function, not revealed by conventional or quantitative assays. Activation of secondary hemostasis was found in both dynamic and nondynamic assays, while changes in fibrinolysis were not convincingly demonstrable in either dynamic or conventional or quantitative assays. Hence, from a mechanistic point of view, desmopressin to prevent rebleeding and heparin to prevent DCI may hold potential as therapeutic options. As changes in fibrinolysis were not convincingly demonstrated and not related to outcome, the use of tranexamic acid prior to aneurysm closure is not supported by this review.
Topics: Brain Ischemia; Fibrin Clot Lysis Time; Fibrinolysis; Hemostasis; Humans; Subarachnoid Hemorrhage
PubMed: 34261149
DOI: 10.1055/s-0041-1730346 -
Aging Jul 2021Platelet activation plays an important role in the progression of pulmonary embolism (PE). Mean platelet volume (MPV) can serve as a marker of platelet activity in... (Meta-Analysis)
Meta-Analysis
Platelet activation plays an important role in the progression of pulmonary embolism (PE). Mean platelet volume (MPV) can serve as a marker of platelet activity in patients with PE. Many studies have reported different results regarding the relationship. Therefore, we aimed to perform a systematic review and meta-analysis to evaluate the relationship between MPV and PE. Two reviewers independently searched relevant articles in databases from inception to April 21, 2021 and identified all studies on MPV and PE as the outcomes of interest. Further, we selected studies meeting the criteria and extracted the data. Of the 2505 publications identified, we included 18 studies after screening. Results showed MPV was significantly higher in patients with PE (0.83 fL, 95% CI: 0.38-1.28, P<0.001) than in controls. The mean difference in MPV between those who died and survivors of PE was 1.23 fL (95% CI: 0.96-1.51, P<0.001). Hence, an increased MPV is associated with PE. MPV could be a useful tool to predict the occurrence and death risk of PE together with other risk factors.
Topics: Biomarkers; Humans; Mean Platelet Volume; Platelet Activation; Predictive Value of Tests; Prognosis; Pulmonary Embolism
PubMed: 34214051
DOI: 10.18632/aging.203205 -
Medical Devices (Auckland, N.Z.) 2021Adequate hemostasis during surgical procedures is essential for successful patient outcomes and reduced healthcare resource utilization. Topical hemostatic agents can... (Review)
Review
Adequate hemostasis during surgical procedures is essential for successful patient outcomes and reduced healthcare resource utilization. Topical hemostatic agents can act as catalysts for the clotting cascade or as a scaffold to promote platelet activation or aggregation. Although an ever-increasing number of topical absorbable hemostatic agents are now available for perioperative use, health care providers are disadvantaged by the lack of comparative data on feasibility, clinical effectiveness, advantages, and limitations of each in specific surgical settings. This knowledge is important for appropriate product choice when patient characteristics, type of surgical procedure, type of bleeding, and product availability may differ widely. This manuscript provides the first comprehensive overview of Avitene™ Microfibrillar Collagen Hemostat (MCH), a bovine collagen-based absorbable hemostat that has been widely used for over four decades in the United States and abroad. MCH is indicated as an adjunct to hemostasis across a broad spectrum of surgical specialties and has been shown to achieve hemostasis with positive patient outcomes and a favorable safety profile in many applications, including hepatic, orthopedic, splenic, oral, and otolaryngologic surgery. Although published clinical data regarding the use of MCH in cardiovascular surgery is limited, evidence suggests moderate use in this specialty. The information contained in this systematic review will help health care providers understand the clinical use and effectiveness of the product to determine appropriate use in differing bleeding scenarios across multiple surgical specialties. Future studies may include comparative functional and cost analyses to explore the economic advantages of using absorbable hemostatic agents compared with each other or with conventional techniques of hemostasis, when appropriate.
PubMed: 34104007
DOI: 10.2147/MDER.S298207 -
Autoimmunity Reviews May 2021Patients with systemic lupus erythematosus (SLE) have a high burden of cardiovascular disease (CVD) of multifactorial origin. The aim of this systematic review is to... (Review)
Review
OBJECTIVE
Patients with systemic lupus erythematosus (SLE) have a high burden of cardiovascular disease (CVD) of multifactorial origin. The aim of this systematic review is to analyze the role of the interferon I (IFN-I) signature and fibroblast growth factor-23 (FGF-23) in patients with SLE or cutaneous lupus erythematosus (CLE) herein.
MATERIALS AND METHODS
We conducted a systematic literature search in PubMed and Scopus using keywords for major adverse cardiovascular events (MACE) and intermediate outcomes (endothelial dysfunction, subclinical atherosclerosis, platelet activation) associated with IFN-I or FGF-23 in patients with SLE and CLE.
RESULTS
4745 citations were screened, of which 12 studies were included. IFN-I was associated with MACE in two third of the studies and the association was strongest for cardiac events. An association of IFN-I was found in all studies investigating impaired vascular function, but only in 50% (respectively 40%) of reports examining the relation of IFN-I and platelet activation (respectively subclinical atherosclerosis). Altogether the reports were of variable bias and quality due to high variability of examined IFN-I biomarkers and inconsistent results for different outcome measures. No studies investigating the cardiovascular risk of circulating IFN-I in CLE, nor FGF-23 in SLE or CLE were found.
CONCLUSION
Clinical studies measuring the association between IFN-I and direct / intermediate measures of CVD are rare and ambiguous in SLE and nonexistent in CLE, hampering a definite conclusion.
Topics: Cardiovascular Diseases; Fibroblast Growth Factor-23; Heart Disease Risk Factors; Humans; Interferon Type I; Lupus Erythematosus, Cutaneous; Lupus Erythematosus, Systemic; Risk Factors
PubMed: 33722754
DOI: 10.1016/j.autrev.2021.102794 -
Medicine Feb 2021Exercise test (ET) may have adverse effects on platelet function and induce acute thrombotic events in patients with coronary artery disease (CAD). The aim of this study... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Exercise test (ET) may have adverse effects on platelet function and induce acute thrombotic events in patients with coronary artery disease (CAD). The aim of this study is to investigate the platelet function and evaluate the risk of thrombotic events in CAD patients during ET.
METHODS
Pubmed, Embase, Cochrane Library, and Web of Science were searched for a systematic review from initiation to October 2019. The inclusion criteria were controlled clinical trails as study design; investigating platelet function in CAD patients during ET; with ET carried out by treadmill or bicycle ergometer; written in English. Included articles were screened based on title/abstract and full-text review by 2 independent reviewers. Platelet aggregation (PA), platelet surface expression of CD62p and PAC-1, plasma levels of platelet factor 4 (PF4) and beta-thromboglobulin (β-TG) were evaluated before and after ET.
RESULTS
Eighteen articles were included out of the 427 references initially identified. In most of the studies included ET was terminated because of limited symptoms. Prior to ET, no difference in platelet aggregation was observed in CAD patients compared with healthy controls in majority of the studies, with or without the treatment with Aspirin. Dual anti-platelet therapy suppressed adenosine diphosphate (ADP)-induced platelet aggregation at rest. After ET, platelet aggregation, the serum levels of β-thromboglobulin were found unchanged in majority of studies and platelet factor-4 were found unchanged in half of studies. The expression of platelet surface markers were elevated by ET in a few study.
CONCLUSION
Symptom-limited exercise test did not affect platelet function in patients with coronary artery disease; however exercise to higher intensity may induce platelet activation.
Topics: Cardiac Rehabilitation; Coronary Artery Disease; Exercise Test; Humans; Platelet Aggregation; Platelet Aggregation Inhibitors; Platelet Function Tests
PubMed: 33663130
DOI: 10.1097/MD.0000000000024932 -
Seminars in Thrombosis and Hemostasis Feb 2021Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by increased platelet counts. ET has an incidence of 0.6 to 2.5 per 100,000 per year in...
Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by increased platelet counts. ET has an incidence of 0.6 to 2.5 per 100,000 per year in Europe and North America. The disease is characterized by an increased thromboembolic risk, possibly caused by increased platelet counts. Furthermore, increased platelet function and/or increased platelet turnover may play a role. We aimed to explore: (1) whether platelet function and platelet turnover are increased in ET patients compared with healthy controls, and (2) whether these parameters are associated with increased thromboembolic risk and, therefore, may support decision-making on treatment in ET patients. We performed a systematic literature search on March 20, 2020 in Embase and PubMed following the Preferred Reporting Items for Systematic and Meta-Analysis (PRISMA) guidelines. In total, 1,923 articles were identified, 38 of which were included according to prespecified inclusion and exclusion criteria. Among the 38 studies, platelet activation (CD36 and CD62P) was investigated in 18 studies and was found to be increased in 12 of these. Platelet aggregation was investigated in 21 studies and was reported to be reduced in 20 of them. Platelet turnover (immature platelet count and mean platelet volume) was investigated in five studies with inconclusive results. No parameters were reported to predict the risk of thromboembolic events. In conclusion, platelet activation was increased in ET patients, but platelet aggregation was reduced. Future studies exploring markers of thromboembolic risk in ET patients are warranted.
Topics: Blood Platelets; Female; Humans; Platelet Function Tests; Thrombocythemia, Essential
PubMed: 33525042
DOI: 10.1055/s-0040-1718873 -
Retina (Philadelphia, Pa.) Feb 2021Platelet count, mean platelet volume, platelet distribution width, and plateletcrit are standard indices of platelet activation that have been studied in retinal vein... (Meta-Analysis)
Meta-Analysis
PURPOSE
Platelet count, mean platelet volume, platelet distribution width, and plateletcrit are standard indices of platelet activation that have been studied in retinal vein occlusion (RVO) and its subtypes: branch retinal vein occlusion and central retinal vein occlusion. This systematic review and meta-analysis aimed to assess the association between these platelet parameters and RVO.
METHODS
We searched for studies investigating the association between these platelet indices and RVO in multiple online databases from inception to August 2020. Mean differences and the associated confidence intervals were obtained and calculated for each included study and pooled using random-effects inverse variance modeling. Meta-regression was used to explore interstudy and intrastudy heterogeneity.
RESULTS
Thousand three hundred and twenty-five unique studies were screened, from which 24 studies encompassing 2,718 patients were included. Mean platelet volume and platelet distribution width were significantly elevated in RVO, with pooled mean differences of 0.45 fL (95% CI 0.24-0.66, P < 0.0001) and 1.43% (95% CI 0.57-2.29, P = 0.0011), respectively. Platelet count and plateletcrit were not significantly associated with RVO. Mean platelet volume was also independently elevated in branch retinal vein occlusion and central retinal vein occlusion.
CONCLUSION
Mean platelet volume and platelet distribution width are significantly elevated in RVO. Further research is required to explore the independence and potential prognostic significance of these associations.
Topics: Humans; Mean Platelet Volume; Retinal Vein; Retinal Vein Occlusion; Risk Factors
PubMed: 33475270
DOI: 10.1097/IAE.0000000000003022 -
Clinical and Applied... 2021Coagulation activation has been reported in several cohorts of patients Coronavirus Disease 2019 (COVID-19). However, the true burden of systemic coagulopathy in... (Meta-Analysis)
Meta-Analysis
Coagulation activation has been reported in several cohorts of patients Coronavirus Disease 2019 (COVID-19). However, the true burden of systemic coagulopathy in COVID-19 remains unknown. In this systematic review and meta-analysis, we performed a literature search using PubMed, EMBASE, and Cochrane Database to identify studies that reported the prevalence of systemic coagulopathy using established criteria in patients with COVID-19. The primary outcome was the prevalence of systemic coagulopathy (disseminated intravascular coagulation [DIC] and/or sepsis-induced coagulopathy [SIC]). Pooled prevalences and 95% confidence intervals [CIs] were calculated using random-effects model. A total of 5 studies including 1210 patients with confirmed COVID-19 were included. The pooled prevalence of systemic coagulopathy was 7.1% (95%CI: 3.2%,15.3%, I = 93%). The pooled prevalence of DIC (N = 721) and SIC (N = 639) were 4.3% (95%CI 1.7%, 10.4%, I = 84%) and 16.2% (95%CI: 9.3%, 26.8%, I = 74%), respectively. Only 2 studies reported the prevalence of elevated D-dimer levels with the pooled prevalence of 84.6% (95%CI: 52.0%,96.5%, I = 94%). Average D-dimer and fibrinogen levels were remarkably increased, while platelet counts, PT, and aPTT ratios were minimally affected in COVID-19. The estimated prevalence of systemic coagulopathy in patients with COVID-19 was low despite D-dimer elevation in most patients. Relatively low systemic coagulopathy in COVID-19 may contribute to the high incidence of thrombosis rather than bleeding in patients with COVID-19.
Topics: COVID-19; Disseminated Intravascular Coagulation; Female; Fibrin Fibrinogen Degradation Products; Humans; Male; Platelet Count; Prevalence; SARS-CoV-2; Sepsis; Thrombosis
PubMed: 33443456
DOI: 10.1177/1076029620987629