The COVID-19 infection caused by SARS-CoV-2 is a healthcare crisis that has led to unparalleled disruption and has impacted healthcare services, leading to significant morbidity and mortality in the worldwide population. Insufficient data on the management of COVID-19 complications such as hypercoagulability and the controversy about the benefits of anticoagulant therapy are major challenges encountered by clinicians, especially for patients with pre-existing cardiovascular diseases (CVD), and are still debatable. Therefore, we endeavored to conduct a systematic review to assess the clinical outcomes of prior anticoagulant therapy in patients with COVID-19 having pre-existing CVD. Electronic searches of the PubMed database and EBSCO Information Services were carried out, and all relevant articles were employed. Seven articles with data from 21,989 subjects were included. Despite the promised clinical outcomes of anticoagulant therapy, the results of the current systematic review indicated insignificant improvements in the reduction of mortality rate or ICU admission among patients with COVID-19 having pre-existing CVD. Furthermore, direct oral anticoagulant (DOAC) were favored over vitamin K antagonists (VKAs) due to better action and less side effects. In conclusion, the findings are controversial as we did not statistically analyze the results. The data showed inconsistent information with no clear effect of anticoagulant use before patient hospitalization or decreasing COVID-19 severity, particularly in those with CVD. Further studies including randomized controlled trials are required to describe the best course as well as optimal dose of anticoagulant use in the treatment of patients with COVID-19, particularly those with comorbidities such as CVD.
Aim: We aimed to study the comorbidities prevalence in patients with sickle cell disease (SCD) with obstructive sleep apnea (OSA).
Method: A computerized search was conducted through six databases. We included all papers that discussed the prevalence of neurological comorbidities in patients with SCD and OSA, whether alone or compared to patients with SCD and without OSA or any comparator. We calculated odds ratios (ORs) with corresponding 95% confidence intervals (95% CI) for stroke rates.
Results: Finally, we included six papers for this systematic review. There was a significant increase in stroke odds among the OSA group compared to the non-OSA one (OR= 1.84; 95% CI= 1.18-2.87; P-value= 0.024), with no significant heterogeneity among the included studies (I2= 36%; P-value= 0.194). Seizure rates showed a significant increase in those with OSA compared to those without it (2.9% vs. 1.7%; P-value< 0.001). The TIA and the silent cerebral infarcts rates were comparable among OSA and non-OSA groups.
Conclusion: OSA imposes a risk of neurological co-morbidities among SCD patients.
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