COVID-19: Thrombosis, thromboinflammation, and anticoagulation considerations.
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2021-07
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Abstract
Vascular endothelial injury is a hallmark of acute infection at both the microvascular and macrovascular levels. The hallmark of SARS-CoV-2 infection is the current COVID-19 clinical sequelae of the pathophysiologic responses of hypercoagulability and thromboinflammation associated with acute infection. The acute lung injury that initially occurs in COVID-19 results from vascular and endothelial damage from viral injury and pathophysiologic responses that produce the COVID-19-associated coagulopathy. Clinicians should continue to focus on the vascular endothelial injury that occurs and evaluate potential therapeutic interventions that may benefit those with new infections during the current pandemic as they may also be of benefit for future pathogens that generate similar thromboinflammatory responses. The current Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) studies are important projects that will further define our management strategies. At the time of writing this report, two mRNA vaccines are now being distributed and will hopefully have a major impact on slowing the global spread and subsequent thromboinflammatory injury we see clinically in critically ill patients.
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Levy, Jerrold H, Toshiaki Iba, Lyra B Olson, Kristen M Corey, Kamrouz Ghadimi and Jean M Connors (2021). COVID-19: Thrombosis, thromboinflammation, and anticoagulation considerations. International journal of laboratory hematology, 43 Suppl 1(S1). pp. 29–35. 10.1111/ijlh.13500 Retrieved from https://hdl.handle.net/10161/23478.
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Jerrold Henry Levy
Jerrold H Levy, MD, FAHA, FCCM, is Professor of Surgery (Cardiothoracic) and Professor Emeritus of Anesthesiology/Critical Care at Duke University Medical Center in Durham, NC. He is also an Adjunct Professor in theDepartment of Pathology and Laboratory Medicine and the Centre for Blood Research at the University of British Columbia. Currently, he serves as Vice Chair of the Scientific and Standardization Committees of the International Society of Thrombosis and Hemostasis and previously served as Chair of the Perioperative and Critical Care Committee. He obtained his medical degree from the University of Miami, where he was a resident in internal medicine, followed by an Anesthesiology residency at the Massachusetts General Hospital/Harvard Medical School, where he was Chief Resident, and completed fellowships in Respiratory Intensive Care and Cardiac Anesthesiology. Before Duke, he was Professor and Deputy Chair for Research at Emory University School of Medicine. Dr Levy is currently an Associate Editor for the Journal of Thrombosis and Haemostasis, an Editor for the European Heart Journal: Cardiovascular Pharmacology, and on the Editorial Board for the Journal of Thoracic and Cardiovascular Surgery, and previously served as an Executive Editor for Anesthesiology. His current clinical and research interests include anticoagulation and its reversal, therapeutic strategies to prevent and treat coagulopathy and acute inflammation in critically ill patients and extracorporeal life support, applications of recombinant and purified protein concentrates for treating bleeding and inflammation, and therapeutic approaches to anaphylaxis. He is the author of over 600 publications on PubMed, with over 100,000 citations, an h-index of 112, and an i10-index of 500. He is also fluent in French and conversational in Spanish and Japanese.
Kristin Corey
Kamrouz Ghadimi
Dr. Kamrouz (Kam) Ghadimi is an experienced cardiovascular acute care specialist (cardiovascular anesthesiology and intensive care), established investigator, physician leader, and adjunct associate professor of Anesthesiology at Duke Health.
His clinical practice is rooted in the cardiothoracic surgical ICU and operating rooms. He has broad expertise in all topics involving perioperative cardiovascular medicine and intensive care, including the management of acutely ill patients after surgery or those receiving extracorporeal life support (ECLS/ECMO). His specific area of expertise focuses on the enhancement of blood circulation through the lungs and the reversal of bleeding with prevention of thrombosis after surgery and circulatory life support. He has published original research, invited reviews, and guidance documents in several high-impact multidisciplinary journals and networks, including JAMA, Circulation, BMJ, Journal of the American College of Cardiology, Journal of Heart and Lung Transplantation, and Journal of Thrombosis & Haemostasis. He has also published in anesthesiology specialty journals, including Anesthesia & Analgesia, Anesthesiology, Current Opinion in Anesthesiology, and the British Journal of Anaesthesia. Dr. Ghadimi has served on the Editorial Board for the Journal of Cardiothoracic and Vascular Anesthesia since 2018 and has served as a peer reviewer for more than 30 top-medical journals worldwide.
Over his career, he has developed a global multidisciplinary network of collaborators and colleagues in academic medicine, private practice, larger healthcare systems, and offices of the federal government. He has experience with grant funding from a variety of sponsors, including federal, industry, foundation, philanthropy, and institutional sources. He also holds positions on several other national and international committees aimed at improving cardiovascular health in patients undergoing surgery and post-surgical intensive care. He is a selected task force and writing committee member of the 2024 American College of Cardiology and American Heart Association Perioperative Cardiovascular Guidelines. He has devoted the majority of his career to the service of patients requiring cardiovascular perioperative and surgical intensive care.
In addition to a doctorate in Medicine, Dr. Ghadimi holds a Bachelor’s in Economics from Boston University and a Master’s in Clinical Research from Duke University School of Medicine and the National Institutes of Health. He is also an inventor with patents/patents pending, a medical consultant, a mentor, and an investor. He is a founding member and the original academic director of True Learn, an eLearning company focused on board exam preparation for multiple medical subspecialties. This resource is used by many physicians around the country. Beyond developing an educational platform that has reached several thousand physicians and physicians-in-training, Dr. Ghadimi has formally mentored 22 pre-doctorate and post-doctorate trainees, with several mentees continuing their faculty careers in academic practice. In addition, he serves as a resource for a multitude of other physicians, physicians-in-training, and allied healthcare professionals.
Dr. Ghadimi previously served as Director of the Clinical Research Unit for the Department of Anesthesiology at Duke Health (2021-2026), leading a cohesive, high-performing management team and working with Anesthesiology faculty and faculty in other departments to operationalize multiple innovative research protocols annually (single- and multi-site studies) to advance the fields of perioperative medicine, intensive care, pain management, and brain and heart health.
Dr. Ghadimi currently serves as Chair for the Division of Surgical Critical Care at Cleveland Clinic in Cleveland, Ohio.
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