Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The risk of venous thromboembolism (VTE) in patients using estrogen contraception is well known. However, the association of progestin-only contraception (POC) and the risk of thrombosis is poorly investigated. Few studies on this topic have failed to prove a significant increase in VTE in patients using POC, including patients with a medical condition associated with an increased risk of thrombosis. Therefore, no specific consideration is warranted when using a POC in healthy young females, regardless of an inherited thrombophilia. We present a case of a young woman who has Factor V Leiden (FVL), presenting with an isolated pulmonary embolism (PE) while using a progesterone containing intrauterine device (IUD). The risk of VTE in FVL carriers seems to outweigh the benefit of contraception even when using progestin-only contraception. Therefore, non-hormonal contraception, such as copper IUD, seems to be the only safe alternative for contraception in this population. Further studies are needed to elucidate this observation. Abbreviation: PE: pulmonary embolism; FVL: factor V Leiden; VTE: venous thromboembolism; POC: progestin only contraception; CBC: complete blood count; CMP: complete metabolic panel; ABG: arterial Blood gas; CTPA: CT pulmonary angiography.
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PMID:Isolated pulmonary embolism in a patient with progestin intrauterine device and factor V Leiden. 3125 71

Coagulopathy has proven to be a common complication of the novel coronavirus SARS-CoV-2, with evidence of elevated D-dimers and fibrin degradation products associated with an increased incidence of thromboembolism. Despite emerging evidence describing the coagulopathy and its clinical relevance in COVID-19, fewer studies have addressed the potential role of empiric therapeutic anticoagulation in this setting. We report the case of a patient admitted to our intensive care unit (ICU) with severe acute respiratory distress syndrome (ARDS) secondary to COVID-19 whose clinical trajectory improved dramatically after initiation of a therapeutic dose of LMWH. The patient showed progressive elevation of fibrinogen and D-dimers despite a prophylactic dose of LMWH during her ICU stay. This was met with a moderate increase of troponin T-hs, an escalating need for vasopressors, and a progressive decrease in her P/F ratio despite preserved lung static compliance. Her platelet count was normal and had an elevated fibrinogen during the first week of ICU stay. The ECG was normal, and a bedside transthoracic echocardiogram showed no evidence of pulmonary embolism and a preserved EF with no regional wall motion abnormalities (RMWA). The chest X-ray was not dissimilar to previous exams, and the ABG showed hypoxia with normal pCO2 values. The decision was made to commence empiric therapeutic enoxaparin. The patient did not experience bleeding complications, and her clinical trajectory appeared to change dramatically. She was successfully extubated three days later and proceeded to clinical recovery and eventual discharge from the ICU. The available evidence shows that there is undoubtedly coagulopathy associated with COVID-19 with various subsequent forms of clinical manifestation described in the literature. Evidence also shows the benefits of heparin as an anticoagulant. From the discussion of this case report, however, it can be concluded that despite the plausible theoretical rationale, studies pertaining to the role of empiric therapeutic anticoagulation in this setting fall short of providing compelling evidence. Subsequently the role of empiric therapeutic anticoagulation in COVID-19 remains unclear with a pressing call for further research.
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PMID:The Role of Therapeutic Anticoagulation in COVID-19. 3290 13