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Hiradipta Ardining
Kediri District Hospital, Kediri, Indonesia
Health Professions Immunology & microbiology Medicine & Pharmacology

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Journal : Heart Science Journal

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Venous Thromboembolism Prevention in COVID-19: A Review of Latest Evidences Muchammad Dzikrul Haq Karimullah; Nisa Amnifolia Niazta; Hiradipta Ardining
Heart Science Journal Vol 1, No 3 (2020): Management of Coronary Artery Disease: From Risk Factors to The Better Long-Term
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2020.001.03.3

Abstract

COVID-19 has become major public health problems, with new cases and deaths growing around the world. COVID-19 has been reportedly associated with hypercoagulable state which can lead to venous thromboembolism (VTE) formation. This condition is also associated with worse outcomes in COVID-19 patients, therefore, it is critical for clinicians to identify this condition and manage it accordingly. VTE formation in COVID-19 occurs through several mechanisms, such as inflammatory reaction leading to hypercoagulable state and vascular dysfunction, direct vascular injury by the virus, and immobilization of the patients. The rate of VTE formation is as high as 31% in ICU patients and 9.2% in general wards patients, and it is also associated with poorer prognosis. Thromboprophylaxis with heparin, particularly low molecular weight heparin (LMWH), has been shown to improve the prognosis in these patients. A careful individual assessment is required to determine which patients will benefit from this therapy, as there are still no sufficient prospective trials to establish guidelines for VTE thromboprophylaxis in COVID-19. The assessment includes laboratory parameters such as PT, platelet count, D-dimer, fibrinogen, and other risk factors incorporated in PADUA risk assessment model (RAM), versus the risk of bleeding incorporated in IMPROVE bleeding RAM.
The Impact of Cardiac Injury on COVID-19 Patients Mortality: A Systematic Review and Meta-Analysis Nisa Amnifolia Niazta; Hiradipta Ardining; Muchammad Dzikrul haq Karimullah
Heart Science Journal Vol 1, No 4 (2020): Acute Coronary Syndrome in Daily Practice : Diagnosis, Complication, and Managem
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2020.001.04.05

Abstract

Background: Cardiovascular system was the second most common organ system affected by COVID-19. Cardiac injury has been reported in many COVID-19 cases. The purpose of this study was to investigate the correlation between cardiac injury with mortality in COVID-19 patients.Methods: We performed a systematic review and meta-analysis study. The relevant studies were identified through scientific electronic databases such as PubMed, Cochrane, and ScienceDirect up to August 2020. The study quality assessment was conducted using the GRADE approach. The pooled odds ratio (OR) and 95% confidence interval (CI) were estimated using the random-effects model.  Results: A total of 10 studies involving 2619 patients were included in the meta-analysis. The incidence of cardiac injury in COVID-19 patients was 28.5%. The all-cause mortality was significantly higher in patients with cardiac injury (52.8% vs. 13.1%; OR = 13.78; 95% CI = 7.22-26.32; I 2 = 88%; Z= 7.95; P < 0.00001).Conclusion: Cardiac injury is associated with higher mortality in COVID-19 patients. The cardiac injury should be considered as an important variable in the risk stratification for mortality in COVID-19. 
Autoimmune Hemolytic Anemia Causing Group 5 Pulmonary Hypertension: A Rare Case Muchammad Dzikrul Haq Karimullah; Hiradipta Ardining
Heart Science Journal Vol 1, No 3 (2020): Management of Coronary Artery Disease: From Risk Factors to The Better Long-Term
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2020.001.03.7

Abstract

Pulmonary hypertension (PH)has been associated with hemolytic anemia. The prevalence of PH in hemolytic anemia is estimated to be as high as 10-40%, and reportsarepresenting poor prognosis in this subset of patients. PH associated with autoimmune hemolytic anemia (AIHA) is still rarely discussed,and there is paucity of literature regarding its precise pathophysiology and treatment. Here, we describe a case of PH associated with AIHA. A 34-year old woman came to our center with chief complaint of dyspnea on exertion. She was previously diagnosed with AIHA with positive direct Coomb's test. Physical examination, chest X-ray and echocardiography were consistent with pulmonary hypertension. The diagnosis of group 5 pulmonary hypertension was made. Although rare, the association between chronic hemolytic anemia and PH is evident, through several mechanisms involving nitric oxide inactivation, direct injury oftheendothelium, oxidative damage, thromboembolic formation, and left ventricular dysfunction. The management of PH in hemolytic disorders comprises treatment of underlying hemolytic disorder and PH-specific therapies. For PH specific therapy, to date, there are no therapies that have been fully studied for these specific patient population. Our patient was given bisoprolol, furosemide, amlodipine, spironolactone, candesartan, beraprost sodium and sildenafil. On follow up twomonths later, her functional status was improved. In summary, PH associated with AIHA develop via multifactorial and complex mechanisms. PH in AIHA could be detected with meticulous history taking, physical examination, chest X-ray and echocardiography, and treatment with vasodilating agents were shown to improve the PH.
Co-Authors Muchammad Dzikrul haq Karimullah Muchammad Dzikrul Haq Karimullah Nisa Amnifolia Niazta