ABSTRACT
BACKGROUND: This study aims to examine risk factors and complications associated with bleeding events in patients with COVID-19 who are on anticoagulation. MATERIAL AND METHODS: We conducted retrospective review of all patients who were admitted with COVID-19 and developed bleeding events between March and June 2020. Data were analyzed in accordance with three major outcomes. Mortality within 30 days of bleeding episode, resolution of the bleeding event, and the type of bleeding event. RESULTS: Of 122 bleeds, there was 55 (28 %) gastrointestinal (GI) bleeds. Overall mortality was 59 % (n = 72). The prevalence of therapeutic invasive interventions was 11.5 % (n = 14) all were successful in resolving the bleeding event. We found that having a GI bleeds was associated with higher risk of mortality compared to non-GI bleeds (p = 0.04) and having occult bleeds to be associated with 15 times increased risk of mortality (OR 15, 95%CI 1.97-29.1, p = 0.01). Furthermore, patients who were on no anticoagulation (none) (OR 0.1, 95%CI 0.01-0.86, p < 0.00), on prophylactic dose anticoagulation (OR 0.07, 95%CI 0.02-0.28, p = 0.03) or intermediate dose anticoagulation (OR 0.36, 95%CI 0.09-1.34, p = 0.13) were less likely to die than patients on therapeutic dose. CONCLUSIONS: The best approach to manage COVID-19 bleeding patients is to prioritize therapies that manage sepsis induce coagulopathy and shock over other approaches. In COVID-19 patients' routine prescription of supra-prophylactic dose anticoagulation should be revisited and more individualized approach to prescription should be the norm. Regardless of the cause of bleeding event it appears that the majority of bleeding events resolve with noninvasive interventions and when invasive interventions were necessary, they were associated with high success rate despite the delay.
ABSTRACT
INTRODUCTION: COVID-19 has presented the surgical community with a multitude of challenges. Patients requiring surgical intervention who are positive for COVID-19 are not only more likely to develop complications post-operatively, but also pose an increased infection risk to the surgical team involved in their care. The infection control concerns raised at the peak of the pandemic persist in the post-pandemic era as patients continue to test positive for COVID-19 and the risk of a 'second wave' looms. METHODS: We present a case series (compliant with SCARE [4] and PROCESS [5] criteria) to demonstrate the effective use of an AR technology platform during the intraoperative treatment of two complex COVID positive patients diagnosed with Fournier's gangrene.Retrospective review of prospectively collected data of all patients that required surgery involving multiple specialties during the COVID-19 pandemic at Jaber AlAhmad hospital in Kuwait between March 2020 to October 2020. PRESENTATION OF CASE: We present two cases to highlight the use of an augmented reality (AR) platform during the treatment of COVID-19 positive patients with Fournier's gangrene in order to safeguard surgical teams whilst simultaneously enabling these complex cases to benefit from multi-specialty input intraoperatively. OUTCOME: Augmented reality is a feasible option to minimize surgeons' exposure during surgery without compromising the patients safety. DISCUSSION: This case series demonstrates how AR solutions can be employed to bolster infection control measures and may be useful in the treatment of surgical patients who test positive for COVID-19. CONCLUSION: AR solutions could be considered as an infection control strategy to safeguard surgical teams operating on COVID-19 positive patients.