Management of Antithrombotic Therapy in Post Percutaneous Coronary Intervention Patient Undergoing Pericardiostomy due to Large Pericardial Effusion: A Case Report

Background : Stent thrombosis is a serious complication following percutaneous coronary intervention (PCI), and dual antiplatelet therapy (DAPT) is necessary to avoid it. Surgery, on the other hand, is a common cause for stopping DAPT. Because patients were exposed to the possibility of a major adverse cardiovascular event (MACE) when DAPT was stopped, this circumstance poses a clinical dilemma. Objective : This case report aimed to describe the management of antithrombotic therapy in post PCI patient requiring DAPT who underwent pericardiostomy. Case : A 69-year-old woman with large pericardial effusion without cardiac tamponade, breast cancer on chemo- therapy, heart failure stage C NYHA functional class II, chronic coronary syndrome post-DES implantation at proximal-mid LAD, and hypertension. The patient underwent pericardiotomy procedures five days after DAPT discontinuation. For the bridging therapy, continuous UFH administration was initiated at a dose of 18 IU/kg/hour after the cessation of DAPT. The UFH dose was adjusted to achieve activated partial thromboplastin time (APTT) 1.5 to 2.0 times the control value. The UFH was discontinued 6 hours before surgery. After surgery, UFH infusion was restarted 6 hours after the confirmation of hemostasis. The administration of UFH then continued until three days after DAPT was restarted. No complications were found during and after the pericar- diostomy. Conclusion : We reported an antithrombotic treatment strategy in a post PCI patient undergoing pericardiostomy with discontinuation of DAPT, which was successfully treated with UFH without any complication. The UFH has been widely used in perioperative settings as a bridging therapy during the interruption of DAPT and may be considered in this condition.

The Combination of Oral PDE5-Inhibitor (Sildenafil) And Oral Prostacy- clin Analogue (Beraphrost) Therapy for Increasing Quality of Life in Adults with Pulmonary Arterial Hypertension Related to Uncorrected Secundum Atrial Septal Defect

Background : Sildenafil, an oral phosphodiesterase type-5 inhibitor, has vasodilatory effects through a cyclic guanosine 3,5-monophosphate–dependent mechanism, whereas beraprost, an oral prostacyclin analog, induces vasorelaxation through a cAMP-dependent mechanism. This combination has often used but there was little detailed study on it Objectives : To investigate whether the combination of oral sildenafil and beraprost is superior to sildenafil alone in in adult patients with Pulmonary Arterial Hypertention (PAH) related uncorrected secundum Atrial Septal Defect (ASD). Methods : Patients with secundum ASD who developed PAH divided into two group. Group A received oral sildenafil 3x40 mg and oral beraphrost 3x20 mcg. Group B received oral sildenafil only 3x40 mg in a 12-week. Health-related quality of life (HRQoL) was recorded by patients using the Medical Outcomes Study 36-item short form (SF-36) questionnaires at baseline and after 12 of therapy. Therapy adherence was achieved through a series of phone calls and a four-weekly hospital visit. Every normal follow-up appointment included an examina- tion of side effects and a dosage modification based on the clinical situation Results: We didn’t found any significant of proportion different in cofounding factor between groups. Compared with Group B, Group A had better functional capacity, limitation to physical health, energy fatigue, pain, and health change (P=0.00, P=0.03, P=0.044, P=0.026, P=0.008, respectively). Conclusion: Combination between oral sildenafil therapy 40 mg three times per day and beraphrost 20 mcg two times per day significantly increase the HRQoL in PAH patients in uncorrected secundum ASD compared sildena- fil alone

The Effect of Bisoprolol on Heart Failure Preserved Ejection Fraction / Hfpef Patient’s Quality Of Life

Background: Global Public Health Burden of Heart Failure reported the growing prevalence of heart failure which is 64.3 million affected in 2020 worldwide with half of the case classified as Heart Failure Preserved Ejection Fraction (HFpEF). It is well known that someone who has been diagnosed with heart failure will have a poorer 􏰼􏰞􏰏􏰦􏰝􏰊􏰗 􏰓􏰒 􏰦􏰝􏰒􏰋􏰷􏰽􏰓􏰬􏰣 􏰾􏰘􏰖􏰦􏰓􏰩􏰿􏰋􏰑 􏰝􏰌 􏰏 􏰜􏰋􏰏􏰑􏰊 􏰑􏰏􏰊􏰋 􏰦􏰓􏰎􏰋􏰑􏰝􏰚􏰟 􏰏􏰟􏰋􏰚􏰊 􏰎􏰝􏰊􏰜 􏰏 􏰐􏰓􏰊􏰋􏰚􏰩􏰗 􏰊􏰓 􏰝􏰔􏰐􏰑􏰓􏰻􏰋 􏰊􏰜􏰋 􏰐􏰏􏰊􏰝􏰋􏰚􏰊􏱀􏰌 􏰩􏰦􏰝􏰚􏰝􏰩􏰏􏰦 outcomes, one of them is QoL. Objective􏱁 􏰥􏰜􏰝􏰌 􏰌􏰊􏰞􏰕􏰗 􏰏􏰝􏰔􏰋􏰕 􏰊􏰓 􏰓􏰖􏰌􏰋􏰑􏰻􏰋 􏰏􏰚􏰕 􏰋􏰻􏰏􏰦􏰞􏰏􏰊􏰋 􏰊􏰜􏰋 􏰋􏰒􏰒􏰋􏰩􏰊 􏰓􏰒 􏰖􏰝􏰌􏰓􏰐􏰑􏰓􏰦􏰓􏰦􏰳 􏰏 􏰊􏰗􏰐􏰋 􏰓􏰒 􏰾􏰘􏰖􏰦􏰓􏰩􏰿􏰋􏰑􏰳 􏰝􏰚 􏰊􏰜􏰋 􏰝􏰔􏰐􏰑􏰓􏰻􏰋- 􏰔􏰋􏰚􏰊 􏰓􏰒 􏱂􏱃􏰐􏰺􏱃 􏰐􏰏􏰊􏰝􏰋􏰚􏰊􏱀􏰌 􏰽􏰓􏰬􏰣 Method: This study is a retrospective cohort following HFpEF patients who received bisoprolol and HFpEF patients who did not receive bisoprolol. The study participants were selected using purposive sampling method. Result: Our study found that from all HFpEF patients who received bisoprolol 102 patients had a good QoL and 2 patients had a poor QoL (p=0.000) according to Minnesota Living With Heart Failure Questionnaire (MLHFQ). The median physical score in the patient who did not receive bisoprolol was 10 while the median score of the 􏰐􏰏􏰊􏰝􏰋􏰚􏰊 􏰎􏰜􏰓 􏰑􏰋􏰩􏰋􏰝􏰻􏰋􏰕 􏰾􏰘􏰖􏰦􏰓􏰩􏰿􏰋􏰑 􏰎􏰏􏰌 􏰲 􏰪􏰐􏰡􏰢􏰣􏰢􏰢􏰢􏰮􏰣 􏰥􏰜􏰋 􏰔􏰋􏰏􏰚 􏰋􏰔􏰓􏰊􏰝􏰓􏰚􏰏􏰦 􏰌􏰩􏰓􏰑􏰋 􏰒􏰓􏰑 􏰊􏰜􏰋 􏰐􏰏􏰊􏰝􏰋􏰚􏰊􏰌 􏰎􏰜􏰓 􏰕􏰝􏰕 􏰚􏰓􏰊 􏰑􏰋􏰩􏰋􏰝􏰻􏰋 􏰾􏰘􏰖􏰦􏰓􏰩􏰿􏰋􏰑 􏰎􏰏􏰌 􏰸 􏰎􏰜􏰝􏰦􏰋 􏰊􏰜􏰋 􏰔􏰋􏰏􏰚 􏰌􏰩􏰓􏰑􏰋 􏰓􏰒 􏰊􏰜􏰋 􏰐􏰏􏰊􏰝􏰋􏰚􏰊􏰌 􏰎􏰜􏰓 􏰑􏰋􏰩􏰋􏰝􏰻􏰋􏰕 􏰾􏰘􏰖􏰦􏰓􏰩􏰿􏰋􏰑 􏰎􏰏􏰌 􏱄 􏰪􏰐􏰡􏰢􏰣􏰢􏰢􏰢􏰮􏰣 Conclusion􏱁 􏰛􏰋 􏰩􏰓􏰚􏰩􏰦􏰞􏰕􏰋 􏰊􏰜􏰏􏰊 􏰊􏰜􏰋 􏰞􏰌􏰋 􏰓􏰒 􏰖􏰝􏰌􏰓􏰐􏰑􏰓􏰦􏰓􏰦 􏰩􏰓􏰞􏰦􏰕 􏰝􏰔􏰐􏰑􏰓􏰻􏰋 􏰊􏰜􏰋 􏱂􏱃􏰐􏰺􏱃 􏰐􏰏􏰊􏰝􏰋􏰚􏰊􏱀􏰌 􏰽􏰓􏰬 􏰋􏰻􏰏􏰦􏰞􏰏􏰊􏰋􏰕 􏰖􏰗 􏰊􏰓􏰊􏰏􏰦 score, physical score, and emotional score.

Current Anticoagulation Recommendation for COVID-19 Patients

Thromboembolic events in COVID-19 patients can be one of the factors that aggravate the disease and increase mortality. When severe hypoxemia and hypotension occur in COVID-19 patients, the possibility of embolism should be considered. As a result, anticoagulant therapy in COVID-19 patients has an essential role in lowering disease severity and mortality. Many studies report that giving anticoagulants to COVID-19 patients can reduce mortality. Therefore, it is important to understand the role and use of anticoagulant therapy in cases of COVID-19. Several guidelines that have been issued by several health organizations in the world and Indonesia can be used as guidelines for clinicians to start anticoagulant therapy in cases of COVID-19. Various anticoagulant drug regimens have also been recommended to be used both as prophylaxis and as therapy for thromboembolism that can occur after COVID-19 cases.

Acute Aorto-Illiac Occlusion with Bilateral Limb Ischemia Underwent Direct Catheter Thrombolysis in Older Patient: A Case Report

Background: Peripheral arterial diseases could be a major burden for the health system with a wide clinical spectrum from asymptomatic to limb-threatening. Sudden onset of limb deteriorations represent a vascular emergency and need proper treatment for limb preservation and life-saving. It is still challenging to choose proper management to reduce morbidity and mortality, despite the various advance in diagnostic and therapeutic tools were available. Objective: This case report aimed to elaborate on the management of acute aorto-illiac occlusion with bilateral limb ischemia underwent direct catheter thrombolysis in an older patient. Case Presentation: A 70-years-old man came to our hospital with a chief complaint of leg pain in both of his legs, suddenly since 18 hours before admission. He had paresthesia and paralysis in both of his legs. And the Doppler ultrasonography result was occlusion proximal to the right and left common iliac artery. Then we performed percutaneous intra-arterial thrombolysis using streptokinase with a successful outcome of peripheral revascular- ization but with gastrointestinal bleeding as an adverse event. Conclusion: Despite the various advancement of diagnostic and therapeutic tools available today, Acute Limb Ischemia (ALI) still proceed to be related to increasing major amputation and mortality rates in 20% of patients, more often due to the existing comorbidities such as other atherosclerotic diseases.

D-dimer Levels as Novel Biomarker Predictor for All-cause In-hospital Mortality Risk in COVID-19 Patients

Background : Coronavirus disease 2019 (COVID-19) has affected people all around the world in varying degrees of severity, causing death. The global case fatality rate (CFR) due to COVID-19 was 2.2 % as of January 1st, 2021. The CFR in the Kediri district is 7.7%, which is higher than the Nasional CFR of 3%. In COVID-19, we looked at high D-dimer as one of the predictors of in-hospital mortality. Objectives : The goal of this study was to find a link between D-dimer levels and all-cause in-hospital mortality in COVID-19 patients, as well as to define the best cut-off point. Methods : A single-center cross-sectional study was conducted. From March to December 2020, 185 COVID-19 patients treated at Kediri General Hospital who were confirmed positive by RT-PCR matched the eligibility criteria. The levels of D-dimer were divided into two groups: those above and those below the cutoff point. We 􏰏􏰚􏰏􏰦􏰗􏰱􏰋􏰕 􏰲 􏰩􏰞􏰊 􏰓􏰒 􏰐􏰓􏰝􏰚􏰊􏰌􏰳 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰢􏰣􏰤 􏰶􏰟􏰷􏰔􏰦􏰳 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰧 􏰶􏰟􏰷􏰔􏰦􏰳 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰸 􏰶􏰟􏰷􏰔􏰦􏰳 􏰏􏰚􏰕 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰲 􏰶􏰟􏰷􏰔􏰦􏰣 The primary endpoint was all-cause in-hospital mortality. Data were collected retrospectively and processed using SPSS version 25.0. Results : 􏰴􏰞􏰑􏰝􏰚􏰟 􏰜􏰓􏰌􏰐􏰝􏰊􏰏􏰦􏰝􏰱􏰏􏰊􏰝􏰓􏰚􏰳 􏰲􏰤 􏰐􏰏􏰊􏰝􏰋􏰚􏰊􏰌 􏰪􏰧􏰲􏰣􏰸􏰹􏰮 􏰎􏰋􏰑􏰋 􏰕􏰝􏰋􏰕􏰣 􏰺􏰦􏰋􏰻􏰏􏰊􏰋􏰕 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰲 􏰶􏰟􏰷􏰔􏰦 􏰎􏰏􏰌 􏰌􏰊􏰏􏰊􏰝􏰌􏰊􏰝􏰩􏰏􏰦􏰦􏰗 significant associated with all-cause inhospital mortality (adjusted odds ratio [OR] 3.46; 95% confidence interval [CI] = 1.41 – 8.49, p = 0.007), with a sensitivity of 82.1% and a specificity of 42.2% ( area under curve [AUC] = 0.628; 95% CI = 0.527 – 0.728; p = 0.012). Conclusion : Elevated D-dimer levels were associated with all-cause in-hospital mortality. In our study, the 􏰓􏰐􏰊􏰝􏰔􏰏􏰦 􏰩􏰞􏰊 􏰓􏰒 􏰐􏰓􏰝􏰚􏰊 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰻􏰏􏰦􏰞􏰋 􏰎􏰏􏰌 􏰲 􏰶􏰟􏰷􏰔􏰦􏰣

The Role of STEMI Communication Network with Major Adverse Cardiac Event Incidence in STEMI Patients Hospitalized in Saiful Anwar General Hospital Malang

Background : Patient with ST-Elevation Myocardial Infarction (STEMI) requires urgent reperfusion either with fibrinolytic or primary Percutaneous Coronary Intervention (PCI). In Malang, a communication network of STEMI has been developed. It connects Saiful Anwar General Hospital with all of the Public Health Centers (PHC) in Malang Raya to shorten system delay since 2015. Objective : To elucidate Malang’s communication network’s role in decreasing Major Adverse Cardiac Event (MACE) in STEMI patients. Methods : This is a retrospective cohort study. Study sample was taken from medical record. Non-network: 96 patients and 88 network patients. Statistical tests using SPSS version 20.0 software. Results : Bivariate analysis showed network-group has a significantly lower MACE (p=0.001). Door-to-balloon time was also lower in network-group (p=0.026). Multivariate analysis without confounder showed that network-group had significantly shorter door-to-reperfusion time (p=0.032) and lower MACE (p=0.035) compared to non-network group. But multivariate analysis with confounder door-to-balloon and door-to-needle failed to explain lower MACE incidence. Network-group (p=0.005) and reperfusion with primary PCI (p=0.05) significantly decreased MACE incidence. Conclusion : Malang’s STEMI communication network and reperfusion with primary PCI reduced MACE in STEMI patients in Saiful Anwar General Hospital Malang.

The Prothrombotic Predominance in Metabolic Syndrome: A Complex Pathomechanism

Patients with metabolic syndrome (MS) have many cardiovascular complications related to atherothrombotic complications. MS contributes premature atherosclerosis, increases platelet activation, promotes coagulation factors, and reduces fibrinolytic activity. The last step in the atherothrombotic cascade is blood clot formation, and altered clot structure is a key role to determine cardiovascular complications. The MS, caused in part by an excess of atherosclerosis and in part by fibrinolytic dysfunction, is profoundly related to an excess of CVD. These combinations of factors involved in MS parameters contribute the increased propensity of people with MS to develop atherothrombosis and fibrinolysis. Awareness and preventive measures are important to improve outcomes in patients with MS.

Arterial Thrombosis Induced By Coagulopathy Due To Coronavirus Infection Concomitant With Heparin Resistance: A Case Report

Background : A newly emerging pandemic of Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 is responsible for significant morbidity and mortality worldwide. As one of the effects is hematological changes related to the COVID-19 infection causing patient tend to thrombosis than hemorrhagic. Current review of evidence and statements on management of coagulopathy and thrombotic complications related to this novel disease is needs to be explored Case : Male 53 years old referred from Private Hospital, due to Severe pneumonia due to COVID-19 and Acute Limb Ischemia. This patient was assessed as Pneumonia COVID-19 severe with acute limb ischemia bilateral grade IIB and performed bilateral surgical thrombectomy with antegrade approach using fogarty catheter with the result was thrombus 10cm along the left femoral artery and thrombus 2cm in the right femoral artery. Discussion : With consideration of atherosclerotic diseases in this patient, we decided to give rivaroxaban as an anticoagulant combined with aspilet and statin high dose. But due to lack of source in our hospital, and patient also denied for further management, treatment for the patient cannot be optimal, so the patient discharge with unresolved limb ischemia. Conclusion : This case showed that the increase risk of heparin resistance in SARS-CoV-2 patient, it is recommend- ed to monitor heparin activity of UFH treatment based on anti-Xa levels instead of aPTT alone.

New York Heart Association Functional Class correlated with Depression: Study in Saiful Anwar Hospital

Background: Heart Failure prevalence was raising as one of the most Objective: to find the correlation of New York Heart Association Functional Class in heart failure patient with Depression Method: This cross-sectional study recruited 342 patients diagnosed with HF with previously for more than 3 months, at dr. Saiful Anwar General Hospital during December 2016 to March 2021. Each patient was interviewed for their demography data, and their clinical data, and assessed for their depression with Montgomery-Asberg Depression Rating Scale for Indonesian version. We used Spearman coefficients (rs) to evaluate the correlations between variables. Results: Baseline characteristic among depression and non-depression group demonstrated no significant difference (p>0.05), but for marital status. Populations was predominantly male, with ACE-i/ARB and Beta-blockers treatment. Non predominant treatment was MRAs, Diuretics, Digoxin. Baseline age was 22 years old until 87 years old. Baseline LVEF was 50.4±12.9%. (p >0.05). There were significant correlations between NYHA Class and marital status (p < 0.05), while the other baseline was not significantly different. We performed log regression for the confounding. The result was NYHA Class significantly correlated with and effects the depression. Conclusion: In heart failure patients, NYHA Class was significantly correlated with depression.