ObjectivesThrombosis is a common complication of the novel COVID-19. Pre-COVID-19 studies reported racial differences in the risk of developing thrombosis. This study aimed to describe the geographical variations in the reported incidences and outcomes of thromboembolic events and thromboprophylaxis in hospitalised patients with COVID-19. The final search for randomised clinical trials was carried out in January 2022. Screening eligible articles and data extraction were independently performed in duplicate by multiple reviewers.DesignScoping review. MEDLINE, Embase, Cochrane Libraries were searched using terms related to COVID-19 and thromboembolism.SettingHospitals all over the world.ParticipantsIn-hospital patients with COVID-19.Outcome measuresThe incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE), and the prophylactic anticoagulation therapy.ResultsIn total, 283 studies were eligible, representing (239 observational studies, 39 case series and 7 interventional studies). The incidence of DVT was the highest in Asia (40.8%) and hospital mortality was high (22.7%). However, the incidence of PE was not very high in Asia (3.2%). On the contrary, the incidence of PE was the highest in the Middle East (16.2%) and Europe (14. 6%). Prophylactic anticoagulation therapy with low-molecular-weight heparin was the main treatment provided in all areas. Four of the seven randomised clinical trials were conducted internationally.ConclusionsThe incidence of DVT was the highest in Asia. The incidence of PE was higher in the Middle East and Europe; however, detection bias during the pandemic cannot be ruled out. There were no major differences in the type or dose of prophylactic anticoagulants used for thromboprophylaxis among the regions.
Background Unfractionated heparin sodium and nafamostat mesylate have long been used as anticoagulants in continuous kidney replacement therapy (CKRT) where citrate is unavailable. This study aimed to determine whether heparin or nafamostat mesylate used during CKRT was associated with a longer filter life. Methods In this single-centre observational study, we included adult patients who required CKRT and used heparin or nafamostat mesylate for their first CKRT in the intensive care unit from September 1, 2013, to December 31, 2020. The primary outcome was filter life (from the start to the end of using the first filter). We used propensity score matching to adjust for the imbalance in patients’ characteristics and laboratory data at the start of CKRT and compared the outcomes between the two groups. We also performed restricted mean survival time analysis to compare the filter survival times. Results We included 286 patients, 157 patients on heparin and 129 patients on nafamostat mesylate. After propensity score matching, the mean filter life with heparin was 1.58 days (N = 91, Standard deviation [SD], 1.52) and with nafamostat mesylate was 1.06 days (N = 91, SD, 0.94, p = 0.006). Multivariable regression analysis adjusted for confounding factors supported that heparin was associated with a longer filter life compared with nafamostat mesylate (regression coefficient, days, 0.52 [95% CI, 0.15, 0.89]). The between group difference of the restricted mean filter survival time in the matched cohort was 0.29 (95% CI, 0.07–0.50, p = 0.008). Conclusion Compared to nafamostat mesylate, heparin was associated with one-third to one-half a day longer filter life. Trial registration Not applicable.
Background Cardiac herniation has been reported in thoracic trauma and after pneumonectomy; however, it is sporadic in cardiac surgery. Case presentation A 35-year-old male patient underwent an elective totally endoscopic robotic-assisted mitral valve repair (TERMVR). His hemodynamics were stable after weaning from cardiopulmonary bypass, and no residual mitral valve regurgitation was observed. However, during suturing of the port wound, the patient developed hypotension, which improved with phenylephrine administration. Four-chamber transesophageal echocardiography (TEE) images showed cardiac deformity, and postoperative chest radiography confirmed the dextrocardia. The cardiac herniation was repaired by deflating the left lung and over-inflating the right lung using a double-lumen tube, allowing selective ventilation without re-thoracotomy. The patient was discharged on the sixth postoperative day without complications. Conclusions This was a very unusual case of cardiac herniation during TERMVR visualized using distinct TEE images. The cardiac herniation was successfully repaired using a double-lumen tube without re-thoracotomy.
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