RESUMO
COVID-19 is a novel disease caused due to infection from the respiratory pathogen SARS CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). It originated from the city of Wuhan in China in December 2019, and spread to become a pandemic in most of the world. The World Health Organization (WHO) declared COVID-19 to be a ‘public health emergency of international concern’ on January 30, 2020. Since then there have been countless cases and associated fatalities. In this article we focus on one aspect of the underlying conditions that may prove to be fatal in critically ill patients of COVID-19, namely hypercoagulative states and their associated thrombotic complications. We analyse data-driven studies that outline the manifold increase in instances of COVID-19 related thrombotic events and the patient demography that is most affected by it. There are several reflections and critical enumerations of the specific clinical features that patients with COVID-19 associated coagulopathies present with. We analyse and comment on several anecdotal instances of patients presenting with new-onset symptoms of severe large-vessel ischemic strokes and other coagulopathies. We determine how laboratory findings and specific markers can help identify patients most at risk of thrombotic events. These events may range from deep vein thromboses to fatal cerebrovascular accidents. There is an increased stress on how these coagulation problems may relate to other infectious conditions through presentation with similar markers. We also analyse the radiological investigations that such patients yield and identify peculiarities in them. There is further emphasis on the importance and efficacy of thrombotic prophylaxis and anticoagulant therapy in the management and reduction of fatalities. We also attempt to educate clinicians and intensive care providers regarding better management practices to mitigate fatal outcomes, including both pharmacological and supportive interventions.
RESUMO
Objective To explore the efficacy and safety of low-dose heparin in the treament of children with primary nephrotic syndrome (PNS). Methods It was an open and comparative trial. Eightyeight children with PNS in the hypercoagulable state,on the basis of administrating with glucocorticosteroid,were administrated with low-dose heparin that infused by micro pump oriented to time ( group A). Eighty patients only treated with glucocorticosteroid were chosen as control (group B). Results Serum-albumin and activated partial thromboplastin time (APTT) increased,but fibrinogen (Fib) decreased after therapy in the group A,and they all showed significant differences (P ＜ 0. 01 ). Serum-albumin increased after therapy in the group B and there was significant difference (P＜0. 01 ). However,APTT and Fib in the group B showed no significant difference( P ＞ 0. 05 ) between post-treatment and pretherapy. Post-treatment serum-albumin and APTT in the group A were significantly higher than those in group B, and Fib was significantly lower than that in group B ( P ＜ 0. 01 ). The rate of urine protein remission in group A (82/88) was significantly higher than that in group B (63/80). Urine protein remission time and edema disappearance time were significantly shorter in group A than group B ( P ＜ 0. 01 ). APTT of group A at the peak concentration of heparin after therapy was significantly higher than that of pretherapy ( P ＜ 0. 01 ), and the ratio was 2. 38. However, there was no significant difference in APTT at the valley concentration of heparin between post-treatment and pretherapy ( P ＞ 0.05 ). Conclusion Low dose-heparin infused by micro pump oriented to time in the treatment of children with PNS has an obvious anticoagulative effect. It can improve the rate of urine protein remission and shorten edema disappearance time. Meanwhile it is safety ,requires no laboratory monitor and has few drug side effects,thus it deserves further clinical application.