BACKGROUND

A 65-year-old man, Filipino, with comorbidities consulted because of shortness of breath. Chest computed tomography scan showed ground-glass opacities and crazy paving patterns (computed tomography severity score = 29). He required oxygen at 4 L/min, with bradycardia. Cardiac enzymes and transthoracic echocardiogram did not show abnormalities. Serial electrocardiogram and electrolytes showed arrhythmia and electrolyte imbalance. Accumulated evidence showed that cardiac involvement is common in patients with COVID-19.1,2 Atrial and ventricular arrhythmia is common even if there is no history of arrhythmia, normal cardiac biomarkers, and transthoracic echocardiogram. Different mechanisms have been proposed for the cause of electrolyte imbalance (see Discussion) that may lead to arrhythmia. Both potassium and calcium were used as a marker of clinical severity and worse prognosis in patients with COVID-19.3,4.

Arrhythmia in COVID-19 patients are more frequent in elderly with comorbidities. Close monitoring and correction of electrolyte imbalance are important to prevent arrhythmia, which can sometimes be fatal.

Introduction: The special needs of cancer patients offer unique challenges in treating them for venous thromboembolism (VTE). Dabigatran is a novel oral anticoagulant (NOAC) that may be comparable to warfarin in clinical benefit and risks of bleeding. A meta-analysis and systematic review was performed to compare efficacy of prevention of VTE recurrence and risks of bleeding with dabigatran compared to warfarin. Methods: Randomized-controlled trials (RCTs) from various sources comparing dabigatran with warfarin for the prevention of recurrence of VTE were then retrieved and analyzed. The efficacy outcomes looked into was recurrence of VTE and mortality related to VTE while the primary safety outcome looked into was major bleeding. Results: This meta-analysis, which included the studies, RECOVER I, RECOVER II, REMEDY showed that VTE and VTErelated deaths occurred in six out of 174 (3.4%) of cancer patients treated with dabigatran while four out of 166 (3.6%) cancer patients treated with warfarin with a relative risk of 1.44 with a 95% CI of 0.41, 5.03 showing no significant difference between dabigatran and warfarin. The REMEDY trial included a total of 60 cancer patients from a total of 1,430 patients in the dabigatran group versus 59 cancer patients from a total of 1,426 patients in the warfarin group. Under the outcome of major bleeding event, among all patients who received dabigatran, 13 patients had major bleeding events, while among those who received warfarin, 25 patients had major bleeding events with a hazard ratio of 0.52 and 95% CI of 0.27-1.02. With the RECOVER I, and RECOVER II, among cancer patients analysed, four patients of the 105 who received dabigatran had major bleeding; while three of the 100 patients who received warfarin had major bleeding with a HR of 1.23 (95% CI of 0.28-5.5). Conclusion The authors conclude that dabigatran is comparable to warfarin in the prevention of recurrence of VTE among cancer patients in terms of both benefits and risks.
Venous Thromboembolism ; Neoplasms