scholarly journals Methodological Issues and Controversies in COVID-19 Coagulopathy: A Tale of Two Storms

2020 ◽  
Vol 26 ◽  
pp. 107602962094539
Author(s):  
Samuel A Berkman ◽  
Victor F Tapson

Venous thromboembolism, occlusion of dialysis catheters, circuit thrombosis in ECMO devices, all in the face of prophylactic and sometimes even therapeutic anti-coagulation, are frequent features of COVID-19 coagulopathy. The trials available to guide clinicians are methodologically limited. There are several unresolved controversies including 1) Should all hospitalized patients with COVID-19 receive prophylactic anti-coagulation? 2) Which patients should have their dosage escalated to intermediate dose? 3) Which patients should be considered for full-dose anti-coagulation even without a measurable thromboembolic event and how should that anti-coagulation be monitored? 4) Should patients receive post-discharge anti-coagulation? 5) What thrombotic issues are related to the various medications being used to treat this coagulopathy? 6) Is anti-phospholipid anti-body part of this syndrome? 7) How do the different treatments for this disease impact the coagulation issues? The aims of this article are to explore these questions and interpret the available data based on the current evidence.

Author(s):  
Samuel A. Berkman ◽  
Victor F. Tapson

AbstractVenous thromboembolism, occlusion of dialysis catheters, circuit thrombosis in extracorporeal membrane oxygenation (ECMO) devices, acute limb ischemia, and isolated strokes, all in the face of prophylactic and even therapeutic anticoagulation, are features of novel coronavirus disease 2019 (COVID-19) coagulopathy. It seems well established at this time that a COVID-19 patient deemed sick enough to be hospitalized, should receive at least prophylactic dose anticoagulation. However, should some hospitalized patients have dosage escalation to intermediate dose? Should some be considered for full-dose anticoagulation without a measurable thromboembolic event and how should that anticoagulation be monitored? Should patients receive postdischarge anticoagulation and with what medication and for how long? What thrombotic issues are related to the various medications being used to treat this coagulopathy? Is antiphospholipid antibody part of this syndrome? What is the significance of isolated ischemic stroke and limb ischemia in this disorder and how does this interface with the rest of the clinical and laboratory features of this disorder? The aims of this article are to explore these questions and interpret the available data based on the current evidence.


1996 ◽  
Vol 76 (06) ◽  
pp. 0887-0892 ◽  
Author(s):  
Serena Ricotta ◽  
Alfonso lorio ◽  
Pasquale Parise ◽  
Giuseppe G Nenci ◽  
Giancarlo Agnelli

SummaryA high incidence of post-discharge venous thromboembolism in orthopaedic surgery patients has been recently reported drawing further attention to the unresolved issue of the optimal duration of the pharmacological prophylaxis. We performed an overview analysis in order to evaluate the incidence of late occurring clinically overt venous thromboembolism in major orthopaedic surgery patients discharged from the hospital with a negative venography and without further pharmacological prophylaxis. We selected the studies published from January 1974 to December 1995 on the prophylaxis of venous thromboembolism after major orthopaedic surgery fulfilling the following criteria: 1) adoption of pharmacological prophylaxis, 2) performing of a bilateral venography before discharge, 3) interruption of pharmacological prophylaxis at discharge in patients with negative venography, and 4) post-discharge follow-up of the patients for at least four weeks. Out of 31 identified studies, 13 fulfilled the overview criteria. The total number of evaluated patients was 4120. An adequate venography was obtained in 3469 patients (84.1%). In the 2361 patients with negative venography (68.1%), 30 episodes of symptomatic venous thromboembolism after hospital discharge were reported with a resulting cumulative incidence of 1.27% (95% C.I. 0.82-1.72) and a weighted mean incidence of 1.52% (95% C.I. 1.05-1.95). Six cases of pulmonary embolism were reported. Our overview showed a low incidence of clinically overt venous thromboembolism at follow-up in major orthopaedic surgery patients discharged with negative venography. Extending pharmacological prophylaxis in these patients does not appear to be justified. Venous thrombi leading to hospital re-admission are likely to be present but asymptomatic at the time of discharge. Future research should be directed toward improving the accuracy of non invasive diagnostic methods in order to replace venography in the screening of asymptomatic post-operative deep vein thrombosis.


Author(s):  
Laura Mora ◽  
Anna Sedda ◽  
Teresa Esteban ◽  
Gianna Cocchini

AbstractThe representation of the metrics of the hands is distorted, but is susceptible to malleability due to expert dexterity (magicians) and long-term tool use (baseball players). However, it remains unclear whether modulation leads to a stable representation of the hand that is adopted in every circumstance, or whether the modulation is closely linked to the spatial context where the expertise occurs. To this aim, a group of 10 experienced Sign Language (SL) interpreters were recruited to study the selective influence of expertise and space localisation in the metric representation of hands. Experiment 1 explored differences in hands’ size representation between the SL interpreters and 10 age-matched controls in near-reaching (Condition 1) and far-reaching space (Condition 2), using the localisation task. SL interpreters presented reduced hand size in near-reaching condition, with characteristic underestimation of finger lengths, and reduced overestimation of hands and wrists widths in comparison with controls. This difference was lost in far-reaching space, confirming the effect of expertise on hand representations is closely linked to the spatial context where an action is performed. As SL interpreters are also experts in the use of their face with communication purposes, the effects of expertise in the metrics of the face were also studied (Experiment 2). SL interpreters were more accurate than controls, with overall reduction of width overestimation. Overall, expertise modifies the representation of relevant body parts in a specific and context-dependent manner. Hence, different representations of the same body part can coexist simultaneously.


HPB ◽  
2020 ◽  
Author(s):  
Cary Jo R. Schlick ◽  
Ryan J. Ellis ◽  
Ryan P. Merkow ◽  
Anthony D. Yang ◽  
David J. Bentrem

2013 ◽  
pp. 269-276
Author(s):  
Marcora Mandreoli ◽  
Antonio Santoro

Despite the high morbidity and mortality associated with venous thromboembolism in hospitalized medical patients with a number of risk factors, and large evidence that prophylaxis is effective, prophylaxis rates remain elusive in medically ill patients. Furthermore, in patients with renal failure, prophylaxis often is omitted or sub-optimal, due to fear of provoking hemorrhage. Patients with end-stage renal disease often have platelet deficits. Low molecular weight heparin (LMWH) therapy may also be difficult to manage in these cases because LMWH clearance is largely dependent on the kidneys. Administration of LMWH to patients with some degree of renal failure may lead to bioaccumulation of anti-Xa activity with an increased risk of bleeding. In recent years, LMWH has largely replaced unfractionated heparin (UFH) for the treatment and prophylaxis of thromboembolic disease. LMWHs have been shown to be superior to UFH in the prevention of venous thromboembolism. They are also easier to administer and do not require laboratory monitoring. However, several case reports and a metaanalysis indicate that the use of LMWHs at therapeutic doses in patients with advanced renal failure can be associated with major bleeding with serious adverse effects. In this paper, we review recent evidence supporting the safety of LMWHs at prophylactic doses in patients with mild or moderate renal disease. Current evidence suggests that bioaccumulation of enoxaparin (the most widely used LMWH) can occur when the drug is used at standard therapeutic doses in patients with severely impaired renal function. This risk can be reduced by empiric dose reduction or monitoring of anti-Xa heparin levels.


2019 ◽  
Vol 19 (1) ◽  
pp. 51-66
Author(s):  
Amri Azhari

There are two different thoughts of the scholars since the last period to the present about the use of Veil. The first thought which oblige a woman Muslim to close the face [Veiled] in front of the male who is not her Mahram; because the face is a primary body part that must be covered. This thought being the opinion of Imam Ahmad bin Hambal, and a strong thought of Imam Syafi'i. The second opinion says Istihbab [Highly recommended], this being the opinion of the Imam Malik and Abu Hanifah's thought and Imam Malik, but, on the other thought of Hanafi and Maliki, since then,  they oblige a veiled woman when they're worried about a slander that will occurr to them. It could happen to her if she is pretty girl, so it appears a libel damages and a malice outbreaking. As this opinion asserted by Al imam Ibn ' Abidin Alhanafi his book [Raddul Muhtar ' Ala Addurul Mukhtar] said: the young girl is prohibited to open her face in the presence of a male [that is not her mahram], it does not because of the face is a body part that must be covered, nevertheless it is concerned as a defamation that occur to the tempted men though his desires are not appeared. Then, the thought about this istihbab is strongly assumed by Shaykh Muhammad al-Albani, a great scholar in the field of Hadith. In addition, he also has a considerable role in enriching the treasure in the field of Islamic law by producing a good works such as the book: (Hijab Almar-ah Almuslimah Fii Alkitaab Wa Assunnah) and a book (Arradul Mufhim ' Ala Man Khalafa Al ulamaa Wa tasyadda Wa ta'shshaba Wa alzama  Almar ata antastura Wajhaha Wa kaffaiha Wa awjaba Wa lam yaqna ' Biqaulihim Innahu Sunnatun  wa Mustahabbun). those two books were his Ijtihad about the use of the veil and islamic law.  Mustahabbun/Sunnah (highly recommended for Muslim women and it does not up to the obligatorily required status). Based on the some Imam Madzhab's thought being compared with the opinions of Shaykh Muhammad al-Albani about the veil, as a result, the author of this scientific works has  aims to explain a different thought among Mutaqaddimin and Muakhkhirin scholars about the veil. I pray to Allah, may Allah gives a great benefits, Aamiin Yaa Rabbal 'alamiin.Para Ulama sejak dahulu sampai sekarang berselisih paham tentang hukum Cadar dangan dua pendapat: yang pertama pendapat yang mewajibkan seorang wanita muslimah untuk menutup wajah [ Bercadar ] didepan laki-laki yg bukan Mahram; dikarenakan Muka adalah Aurat yang wajib di tutut, hal ini menjadi pendapat Imam Ahmad bin Hambal, dan pendapat yang kuat dalam madzham Imam Syafi’. Yang kedua pendapat yang mengatakan Istihbab [ Sangat di anjurkan] , ini menjadi pendapat Madzhab Imam Abu Hanifah dan Imam Malik, Namun di sisi lain para ulama Hanafi dan Maliki- sejak dahulu kala meraka mewajibkan wanita bercadar ketika di khawatirkan terjadinya fitnah yang akan menimpanya; hal tercebut bisa terjadi jika seorang wanit yg cantik maka timbullah fitnah berupa kerusakan dan merebaknya kefasikan. Sebagaimana pendapat ini di tagaskan oleh Al imam Ibnu ‘ Abidin Alhanafi di dalam kitab beliau [ Raddul  Muhtar  ‘Ala  Addurul Mukhtar ]  berkata: Wanita yg masih muda di larang membuka wajah di hadapan laki-laki [ yg bukan mahram baginya] , bukan karena wajah iyu Aurat , namun khawatir fitnah yg akan menimpa laki- laki seperti terlena/ tergoda walaupun tidak bangkit syahwatnya. Lalu pendat yg mengatakan Istihbab ini di kuat oleh Syaikh Muhammad Nashiruddin al Albani, beliau adalah seorang yang mampuni dalam bidang hadits. Di samping itu beliau juga memiliki peran yang cukup besar dalam memperkaya khazanah  dalam bidang hukum-hukum Islam dengan karya-karya yang bermutu semisal buku beliau:  ( Jilbab Almar-ah Almuslimah Fii Alkitaab Wa Assunnah ) Dan kitab  ( Arradul Mufhim ‘Ala Man Khalafa Al ulamaa Wa tasyadda Wa ta’shshaba Wa alzama Almar-ata An Tastura Wajhaha Wa kaffaiha Wa awjaba Wa lam yaqna’ Biqaulihim Innahu Sunnatun Wa Mustahabbun .dua  buku tersebut merupakan Ijtihad beliau tentang hukum Cadar  dalam huk um Islam yaitu: Mustahabbun/ Sunnah ( Sangat di anjurkan bagi wanita muslimah dan tidak sampai ke status Wajib). Berangkat dari pendapat Para Imam- imam Madzhab dan di bandingkan dengan pendapat Syaikh Muhammad Nashiruddin al Albani tentang Cadar, maka Penulis karya Ilmiah ini bertujuan untuk menjelaskan khilafiyah di antara ulama Mutaqaddimin dan Muakhkhirin tentang Cadar tersebut. Saya berdoa kepada Allah Suabhanu Wata’aala memberikan Manfa’at  yang  besar, Amiin Ya Rabbal ‘Alamiin .   اختلاف العلماء قديماً، وحديثا في حكم النقاب على قولين: الأول: يجب على المرأة ستر وجهها أمام الرجال الأجانب؛ لأن الوجه عورة، وهو مذهب الإمام أحمد، والصحيح من مذهب الشافعي، الثاني: استحباب النقاب، وهو مذهب أبي حنيفة ومالك، لكن أفتى علماء الحنفية والمالكية - منذ زمن بعيد - أنه يجب على المرأة ستر وجهها، عند خوف الفتنة بها أو عليها، والمراد بالفتنة بها: أن تكون المرأة ذات جمال، والمراد بخوف الفتنة عليها، أن يفسد الزمان بكثرة الفساد وانتشار الفساق؛ قال "ابن عابدين الحنفي" في (رد المحتار على الدر المختار): "وتمنع المرأة الشابة من كشف الوجه بين رجال، لا لأنه عورة، بل لخوف الفتنة كمسه وإن أمن الشهوة. إن العلماء الذين يقولون باستحباب حكم النقاب لقد أيده الشيخ محمد ناصر الدين الألباني, كان رجلا بارعا في المجال الحديثي وله مساهمة غير قليلة في إثراء المكتبة الفقهية الإسلامية بالمؤلفات المفيدة منها: جلباب المرأة المسلمة في الكتاب والسنة والرد المفحم على من خالف العلماء وتشدّد وتعصب وألزم المرأة أن تستر وجهها وكفيها وأوجب ولم يقنع بقولهم: إنه سنة ومستحب, ومنخلال كتابيه راى وأخذ القول مجتهدا أن النقاب مستحب/ سنة وليس بواجب. انطلاقا من أراء العلماء المتقدمين والمعاصرين ثم المقارنة باجتهاد الشيخ الألباني عن النقاب, فلبى الباحث كتابة هذه الرسالة مبيّناً عن خلافية العلماء في أحكام النقاب, الله أسأل أن يمن علي الأجر والنفع الكبير, ويرزقنا العمل الصالح, آمين يا رب العالمين


2021 ◽  
Vol 24 (2) ◽  
pp. 39-41
Author(s):  
Fabiana Di Stasio ◽  
Angela Amoroso ◽  
Naire Sansotta ◽  
Valeria Casotti ◽  
Lorenzo D'Antiga

Venous thromboembolism (VTE) is a serious extraintestinal complication of inflammatory bowel disease (IBD). Patients with IBD have a VTE risk 3 times greater than those without IBD. IBD children are exposed to that risk as well but with lower incidence compared to adults, 9 events per 10,000 patients per years in children. The acute IBD flare is a predisposing factor to VTE. The management of thromboembolism in IBD patients includes treatment of a thromboembolic complication and secondary prophylaxis of the recurrence of a thromboembolic event. The paper reports a case of a boy with ulcerative colitis who developed cerebrovascular VTE during IBD flare.


2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Bridget Heijkoop ◽  
Natalie Parker ◽  
George Kiroff ◽  
Daniel Spernat

Abstract Background Venous thromboembolism (VTE) is a common postoperative complication associated with significant morbidity and mortality. The use of prophylactic heparin postoperatively reduces this risk, and the use of extended duration prophylaxis is becoming increasingly common. Malignancy and pelvic surgery both independently further increase the risk of postoperative VTE and patients undergoing major pelvic surgery for malignancy are at particularly high risk of VTE. However, the optimum duration of prophylaxis specifically in this population currently remains unclear. Methods We will conduct a systematic review of literature in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0.,2011) to evaluate current evidence of the effectiveness and safety of inpatient versus extended VTE prophylaxis with heparin (all forms) following major pelvic surgery for malignancy. We will search PubMed, EMBASE, and the Cochrane Library. Regarding safety, Food and Drug Administration (FDA), and Therapeutic Goods Administration (TGA) websites will be searched, including all levels of evidence. Results will be the postoperative timeframe in which a VTE event can be considered to have been provoked by the surgery, and the number of patients needed to treat with both inpatient and extended prophylaxis to prevent a VTE event in this timeframe, comparing these to determine if there is a significant benefit from extended prophylaxis. Discussion This systematic review will aim to identify the postoperative period in which patients undergoing major pelvic surgery for malignancy are at further increased risk of VTE as a result of their surgery and the optimum duration of heparin VTE prophylaxis with heparin to reduce this risk. Determining this will allow evidence-based recommendations to be made for the optimum duration of heparin VTE prophylaxis post major pelvic surgery for malignancy, leading to improved standards of care that are consistent between different providers and institutions. Systematic review registration In accordance with guidelines, our systematic review was submitted to PROSPERO for consideration of registration on 16/12/17 and was registered on 12/1/18 with the registration number CRD42018068961, and it was last updated on December 1, 2018.


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