The short-term effect of the COVID-19 pandemic on the management of warfarin therapy.

Aim    The aim of this study was to investigate the short-term effect of the COVID-19 pandemic on the management of warfarin therapy used for atrial fibrillation (AF) and prosthetic valve disease.Material and methods    The study included 139 Atrial fibrillation (AF) patients and 173 prosthetic valve patients (PVP) who were using warfarin. The time in therapeutic range (TTR), International Normalized Ratio (INR) averages, the numbers of INR tests, and the non-adherence to INR monitoring (NIM) were compared for the pre-covid period (PCP) and the COVID-19 period (CP). Also, adherence to warfarin therapy was evaluated with a questionnaire.Results    For all patients, the INR values were higher in the CP (2.47 vs 2.60, p<0.001), and the NIM percentage was higher (19.2 % vs 71.5 %, p<0.001) in the CP. The number of INR tests was lower during the CP (p<0.001).The percentage of patients with TTR≥70 % was lower during the CP (41.7 % vs 33 % p=0.017). Subgroup analysis showed that for PVP, TTR values and the percentage of patients with TTR ≥70 % were similar in both the PCP and CP periods. The questionnaire showed that for 94.1 % of respondents, the major cause of NIM in the CP was the COVID-19 pandemic. However, during the CP, adherence to warfarin medication was high (95.5 %).Conclusion    Lower TTR during the COVID-19 pandemic can increase bleeding and thromboembolic cases.Therefore, patients taking warfarin should be followed more closely, and more practical ways should be considered for INR testing.

A Case Report: Unexpectedly Earlier Recurrence of COVID-19 Infection with Severe Cardiac Involvement (preprint)

ABSTRACT Background COVİD 19 is a relapsing and reccurrent infectious disease caused by SARS-CoV-2. It can be associated with cardiac pathologies . we present a case of COVİD 19 reinfection leading to cardiac involvement . Case Summary A 22 year old men who had a history of COVID-19 pneumonia one and a half month ago arrived at the emergency department with progressive dyspnea. He was . under treatment for chronic idiopathic urticaria with levocetirizine dihydrochloride .He was hypoxic, tachycardic and hypotensive. Thorax computed tomography images demonstrated bilateral ground-glass opacity ,right-sided pleural effusion and cardiomegaly, Bedside transthoracic echocardiography revealed global Left Ventricul (LV)systolic dysfunction with ejection fraction of%28, dilation of the LV cavity and anteriorly directed eccentric jet of severe mitral. regurgitation .The COVID-19 RT-PCR test was re-positive. whereas the blood cultures remain negative. Coronary angiogram performed was normal.The patient improved clinically within one week by furosemid, dopamin favipravir methylprednisolone and antibiotic treatments. C-reactive protein (CRP) levels returned to normal.. The follow-up echocardiography showed normal. ejection fraction and mild mitral. regurgitation. Conclusion This case highlights characteristics of