Parenteral and Oral Anticoagulant Treatment for Hospitalized and Post-Discharge COVID-19 Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: The use of anticoagulants has been endorsed by different hematological societies as coagulation abnormalities are key features of COVID-19 patients. This systematic review and meta-analysis aims to provide the most recent update on available evidence on the clinical benefits and risk of oral and parenteral anticoagulants, as well agents with anticoagulant properties, in hospitalized and post-discharge COVID-19 patients. METHODS: This systematic review synthesizes data on the outcome of anticoagulation in hospitalized and post-discharge COVID-19 patients. Dichotomous variables from individual studies were pooled by risk ratio (RR) and their 95% confidence interval (95% CI) using the random-effects model. Meta-analyses were performed when feasible. RESULTS: We included 32 studies from 2.815 unique citations, including 7 randomized clinical trials. A total of 33.494 patients were included. Outcomes measured include mortality and survival rates, the requirement for ICU care and mechanical ventilation. A pooled meta-analysis favors anticoagulant compared to no anticoagulant with reduced mortality in hospitalized patients (RR 0,55; 95%CI 0,43-0,66; p<0,001). Higher dose of anticoagulant also showed treatment benefit compared to standard prophylactic dose in selected populations (RR 0,68; 95%CI 0,40-0,96; p<0,001). Regular, pre-hospital anticoagulation prior to hospitalization yielded mixed result. There are currently no data on the benefit of anticoagulation on post-discharge COVID-19 patients. CONCLUSION: Determination of the presence of thrombosis in COVID-19 is important, as therapeutic dosage of anticoagulants, rather than prophylatic dose, would be indicated in such clinical situation. Anticoagulants were found to decrease the mortality of hospitalized COVID-19. The results from this study are important in the tailored treatment of COVID-19 patients. Further studies on the need for oral anticoagulation for outpatients or post-discharge is warranted. This study has been registered in PROSPERO database (CRD42020201418).

Underutilization of anticoagulant for venous thromboembolism prophylaxis in three hospitals in Jakarta.

AIM: to assess the current use of anticoagulants and implementation of International Guidelines in venous thromboembolism (VTE) prophylaxis in hospitalized patients with acute medical illnesses in Jakarta, Indonesia. METHODS: a multicenter, prospective, disease registry, recruiting patients diagnosed as acutely ill medical diseases and other medical conditions at risk of VTE, with in-hospital immobilization for at least 3 days. RESULTS: of 401 patients, 46.9% received anticoagulants which included unfractionated heparin (64.4%), fondaparinux (11.7%), enoxaparin (9.6%), warfarin (3.7%), and combination of anticoagulants (10.6%). VTE prophylaxis using physical and mechanical method was used in 81.3% of patients, either as a single modality or in combination with anticoagulants. During hospitalization, VTE were found in 3.2% patients; 10 patients (2.5%) had lower limb events and 3 patients (0.75%) had a suspected pulmonary embolism. The main reference international guidelines used were AHA/ASA 2007 (47.4%), followed by ACCP 2008 (21.7%). CONCLUSION: the study showed underutilization of prophylaxis anticoagulants in which mechanical thromboprophylaxis either alone or combination with anticoagulants was the most commonly used. Unfractionated heparin was the preferable choice. The most commonly used guideline was AHA/ASA 2007. VTE thromboprophylaxis in medically ill patients needs to be encouraged.

Five-Year Cancer Epidemiology at the National Referral Hospital: Hospital-Based Cancer Registry Data in Indonesia.

PURPOSE: In 2016, there were 1,308,061 cases of cancer being treated in Indonesia, with 2.2 trillion rupiahs spent, amounting to $486,960,633 in US dollars (purchasing power parity 2016). The high burden of cancers in Indonesia requires a valid data collection to inform future cancer-related policies. The purpose of this study is to report cancer epidemiological data from 2008 to 2012 based on Hospital-Based Cancer Registry (HBCR) data from Cipto Mangunkusumo Hospital, Indonesia. METHODS: This was a descriptive study with cross-sectional design. Data were collected from Cipto Mangunkusumo Hospital HBCR 2008-2012. Demographical, diagnostic, stages of cancer, and histopathological types of cancer data were extracted. RESULTS: After screening, 18,216 cases were included. A total of 12,438 patients were older than 39 years of age (68.3%), with a female-to-male ratio of 9:5. Most patients have cancers at advanced stages (stages III and IV, 10.2%). The most common sites of cancer were cervix uteri (2,878 cases, 15.8%), breast (2,459 cases, 13.5%), hematopoietic and reticuloendothelial systems (1,422 cases, 7.8%), nasopharynx (1,338 cases, 7.4%), and lymph nodes (1,104 cases, 6.1%). CONCLUSION: From this HBCR, cancer incidence in female was almost twice the incidence in male, largely because of the burden of cervical and breast cancers. The cervix uteri as one of the top five cancer sites based on this HBCR, 2008-2012, are still approximately consistent with Global Cancer Incidence, Mortality and Prevalence 2018, which portrayed that Indonesia has been severely afflicted by cervical cancer cases more than any other Association of Southeast Asian Nations countries. The HBCR could serve as a robust database of epidemiological data for cancer cases in Indonesia.

Clinical characteristics and hematologic responses to Imatinib in patients with chronic phase myeloid leukemia (CML) at Cipto Mangunkusumo Hospital.

AIM: To analyze the clinical characteristics of patients with chronic phase CML and evaluate complete hematologic responses (CHR) and overall survival (OS) after treatment with Imatinib. METHODS: This is a cross sectional study using retrospective medical record of patients with chromosome Philadelphia positive and/or BCR-ABL positive chronic phase CML at the polyclinic of Teratai Department of Internal Medicine Cipto Mangunkusumo National Hospital during 2003-2008. In a period of 6 years, we included 53 patients with chromosome Philadelphia positive and/or BCR-ABL positive chronic phase CML. Patients were administered Imatinib 400 mg daily and then evaluation of clinical characteristics and complete blood count + differential count were performed every 2 weeks until CHR achieved at 3 months as defined by white cells count < 10,000/mm3, platelet count > 450,000/mm3, and non palpable spleen. RESULTS: The median age was 37 years (16-67 years). Males were slightly more frequent than females (29 v.s. 24) with ratio of 1.2:1. Thirty three percent of patients had splenomegaly. The vast majority (60%) of patients had previous treatment with Hydroxyurea. The laboratory features were: median of hemoglobin level was 10.0 g/dL (6.3-16.6 g/dL), median of white-cell count was 13,300/uL (1900-621,000/uL), and median of platelet count was 424,000/uL (108,000-4,400,000/uL). Median of basophils was 1.6% (0%-20%) and 88% of patients had <5% blasts in bone marrow. CONCLUSION: A CHR was achieved in 74% of patients and overall survival during the study was 66%. The most common adverse events were: nausea, myalgia, hypopigmentation of the skin, anemia, thrombocytopenia, and neutropenia.

Reduced bone mineral density and serum C-telopeptide concentration in HIV-infected patients in Cipto Mangunkusumo Hospital.

AIM: To evaluate BMD and bone resorption marker in HIV-infected patients in Cipto Mangunkusumo Hospital, Jakarta. METHODS: A cross-sectional study was performed between February and May 2008 in adult HIV-infected patients who had not been treated with antiretrovirals. BMD was measured at the lumbar spine by dual energy X-ray absorptiometry (DEXA) bone densitometer (Lunar Prodigy, GE Medical System, USA), whereas CTX (C-terminal telopeptide) was measured by an automated analyzer (Elecsys 2010, Roche Diagnostics GmbH, Mannheim, Germany) using the b-Crosslaps serum reagents. RESULTS: Fourty-two patients were included, comprising 31 (73.8%) men and 11 (26.2%) women. Patients' median age was 28 years, ranging from 22 to 39 years old. The peak age group was 26-30 years old. Low BMD (osteopenia) was found in 11 (26.2%) of patients. Mean serum CTX level was significantly correlated with BMD (r=0.446; p=0.003). CONCLUSION: Patients with low CD4 count and low BMI tended to have higher serum CTX. HIV-infected, treatment-naive patients possess a significant risk for reduced BMD due to increase bone resorption activity. Further studies are needed to evaluate the association of disease severity and bone resorption markers.