ABSTRACT
Spontaneous aortic thrombosis is rare, and prompt diagnosis is needed whenever encountering a case of unexplained abdominal pain. The cause of the thrombosis needs to be evaluated thoroughly to rule out any underlying thrombophilias.
ABSTRACT
BACKGROUND: The use of anticoagulant bridging remains controversial. This study was conducted to evaluate our warfarin periprocedural management in Qatar and investigate the associated clinical outcomes with such management. METHODS: A prospective cohort study was designed to describe the periprocedural clinical practice in warfarin patients in Qatar and to compare clinical safety and efficacy outcomes between anticoagulant bridging and nonbridging. RESULTS: 103 patients were recruited. Bridging occurred in 82% of the participants. No thromboembolic events were observed, while 39.1% of patients experienced bleeding events during the study period. The incidence of overall bleeding and major bleeding were numerically higher for bridging group compared to nonbridging but did not reach statistical significance ([30.6% vs 22.2%, Pâ¯=â¯0.478] and [12.9% vs 5.6%, Pâ¯=â¯0.375], respectively). CONCLUSION: Warfarin interruption and bridging are overwhelmingly used in warfarin-treated patients in Qatar. While bridging was numerically associated with increased bleeding events, there is no statistical difference in reported clinical events between bridging and nonbridging strategies.
Subject(s)
Anticoagulants , Elective Surgical Procedures , Hemorrhage/chemically induced , Heparin , Thromboembolism/prevention & control , Warfarin , Adult , Aged , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Female , Hemorrhage/etiology , Hemorrhage/prevention & control , Heparin/adverse effects , Heparin/therapeutic use , Humans , Male , Middle Aged , Perioperative Care , Prospective Studies , Qatar , Thromboembolism/etiology , Treatment Outcome , Warfarin/adverse effects , Warfarin/therapeutic use , Withholding TreatmentABSTRACT
Hamad General Hospital Anticoagulation Clinic is one of the largest collaborative-practice clinics of its type in Qatar. The patients being followed at this clinic are typically complex and vulnerable. During the coronavirus disease 2019 pandemic, measures were implemented at the clinic to minimize the exposure of patients and healthcare providers to the acute respiratory syndrome coronavirus-2 and to promote social distancing. These measures included extending INR-recall period, transitioning to direct oral anticoagulant drugs whenever feasible, home visits to elderly and immunocompromised patients for INR testing, establishing an anticoagulation hotline, and relocation of warfarin dispensing from the main pharmacy to the anticoagulation clinic. In addition, the clinic shifted its multidisciplinary team meetings onto an online platform using Microsoft Teams. Telehealth consultations were extensively utilized to closely follow up with the patients and ensure that anticoagulation efficacy and safety remained optimal. The aim of this paper is to share our experience and describe the measures adopted by the clinic as part of the Hamad Medical Corporation response to the emerging situation.
