TAVR has been associated with early valve thrombosis, characterized by thrombus formation in the prosthetic valve with or without valve dysfunction. This dysfunction is related to leaflet thickening and reduced motion, reduced effective orifice area, or increased transvalvular gradient. A multidetector CT scan allows the dynamic assessment of valves and ruling out fibrosis vs. thrombosis. …
CRUNCH Registry: An Option for Underexpanded Stents
Coronary calcification hinders both stent transfer and implantation, and has been associated with a higher risk of complications. Coronary perforation is the worst of them. In turn, these calcifications affect the preparation of coronary plaque, resulting in an underexpanded stent (US), which is a strong predictor of restenosis and early thrombosis. For the management of…
Are Antithrombotics Necessary in Outpatients after COVID-19?
According to this recent study (soon to be published in JAMA), antithrombotic therapy has no clinical benefits for outpatients with stable symptoms of COVID-19. Both aspirin and apixaban in therapeutic or prophylactic doses did not reduce major cardiovascular events compared against placebo, though these events are rare, which makes it difficult to show any benefit. …
Thrombotic and Bleeding Risk after TAVR: Quick Tips to Stay Up to Date
Transcatheter aortic valve replacement (TAVR) is an increasingly frequent option for patients with severe aortic stenosis across the entire risk spectrum. However, TAVR involves bleeding and thrombosis risk and therefore calls for an optimal adjuvant treatment. Any scheme is complex if we take into account most patients undergoing TAVR are generally elderly and have multiple…
Heparin Anticoagulation in Critically Ill COVID-19 Patients: Results that Differ from the Rest
In critically ill COVID-19 patients, an initial strategy of anticoagulation with heparin did not result in any benefit compared with standard prophylactic treatment. Thrombosis and inflammation are the main issues when discussing COVID-19 related morbidity. This led to testing whether an anticoagulation scheme could improve prognosis in critically ill COVID-19 patients. Given the dynamics of…
Surviving Covid-19 with Good Old Heparin?
Patients hospitalized for COVID-19 are at high risk for thrombosis, particularly venous thromboembolism. This information is not new: in a meta-analysis of 66 studies, the overall prevalence of venous thromboembolism among patients with COVID-19 admitted to intensive care units was between 14.1% and 22.7%. Hypercoagulability is an early-described feature of this new virus, and so is…
Anticoagulation with Heparin in Non-Critical COVID-19
In non-severe COVID-19 patients, an initial therapeutic strategy with heparin increases the chance of survival after discharge and reduces the need for respiratory and cardiovascular support compared against usual thromboprophylaxis doses. These data have been welcomed by a medical community eager to receive good news in terms of effective strategies to combat an already existing…
Diagnosis and Treatment of Vaccine-Induced Thrombosis
Cerebral venous sinus thrombosis is an extremely rare manifestation of cerebrovascular disease. In the last few days, this pathology has sadly gained fame due to its association with two vector-based vaccines against SARR COV19. These are Ad26.COV2.S (Johnson & Johnson) and ChAdOx1 nCoV-19 (AstraZeneca). There have not been any reports of thrombosis or thrombocytopenia from…
Thrombocytopenia and Thrombosis May Be Linked to AstraZeneca Vaccine, Analysis Reports
This is one of the first papers documenting rare thrombotic effects related to the ChAdOx1 nCoV-19 vaccine in Austria and Germany. These effects may be a type of thrombocytopenia after inoculation with the vaccine developed by Oxford University and AstraZeneca. This paper, published in the prestigious New England Journal of Medicine (NEJM), has received plenty…
Major Cause of Myocardial Injury by COVID-19
The most common cause of myocardial necrosis in patient undergoing COVID-19 infection is microthrombi. These microthrombi resulted quite different in composition vs. thrombi obtained from COVID-19 negative patients and thrombi obtained from infected patients with ACS. Myocardial injury is common in patients hospitalized for COVID-19 and has worse prognosis. Regardless its frequency, the mechanism and…
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