হাবিজাবি-১৫৮

Liton Roy Sir, I was learnt it from my Sir, and these criterias is widely used in UK to have such decision when required.

Kawsar UddinWe use long term anticoagulant for... 1) ICU or ventilator patients who are bed ridden or who needed therapeutic dose for 4 wks 2) Confirmed thromboembolism both clinically or radiologically for 3-6 months 3) Those moderate to severe case who need escalation of anticoagulant due to clinical or lab deterioration (gradually increase D-dimer or D-dimer>3mg, ferritin >1000,LDH,CRP>100...). for 4 wks I like your post & ur simplicity.. Be well,Stay safe

Liton Roy Sir, thanks a lot for such valuable informative comment.

Mahbub Mutanabbi Sir, it is better to do a follow up d-dimer in his asymptomatic negative stage at home. As because many patients are taking at home anticoagulant LMWH. So, if d-dimer is more than 400 ng, then it is better to continue his previous LMWH as post prophylaxis, or switch over to oral for a certain period.

Noor E Elahi Raju Bhai, continue as usual if pt is taking it for IHD.

Nowshin Jabin obviously.

Kawsar Uddin under which criteria? Admission d dimer >3k?

Sumiya Sultana SpO2 usually coincides with raised level of these markers. Some other may have raised level due to their preexisting risk factors, and other hepatic and renal disease conditions. So whenever pt is symptomatic, or who have other risk factors, it is better to have frequent follow up if possible, at least weekly. It will notice the existing event, or future event which are to be happened in large.

Khandker Mahbub Uz Zaman Egula ki kos kothin kothin kotha fit test r seal test korte kortei to shesh!! R PPP pora tai to Shikhi nai ei Shob score abar kemne korbo??!!??

Sheikh Nazmul Islam ...thik e bolcish...amra akhn o PPP porai shikte parlam na...

Khandker Mahbub Uz Zaman Sir, thanks for your valuable opinion.

Khandker Mahbub Uz Zaman nice summary!

Khalid Sayfullah not it is required a follow up d-dimer, if it is more than 0.4 in her asymptomatic fit stage, than it is way better to give LMWH as pregnancy itself is s thromboembolic condition. Care is mandatory before delivery to avoid any unwanted post partum bleeding event.

Khalid Sayfullah in case of pregnancy reference value of D- dimer is a bit higher, considering risk benefit calculation heparin can only be used.

Rabiya Ritu esc guideline rivaroxaban recomend kore

Rabiya Ritu It is not mandatory for all, and what I said is practised in several world class hospitals in other countries. Unnecessary and unwise anticoagulant use might bring some unwanted bleeding event as documented in several cases. So, everything must be rational, as body's own anticoagulant pathway will take the upper hand after infection.

Afsana Tasnim Nabila InshaAllah she will be OK soon. Her d-dimer is within normal limit, and she already crossed a significant period without any unwanted event even after having some risk factors. So considering all these she is a mild case, and LMWH is not required.

Kawsar Uddin thank you sir

Muhammad Mishal mg/l is equal to microgram/ml. So, 0.2 mg/l will be 0.2 microgram/ml.

Mohammad Mamun clinical judgment.

Currently we are giving it in following ways during discharge(if d-dimer can't be done): 1. Any patients with severe symptoms and co-morbidity. 2.Every Moderate to critical cases. 3.X-ray and CT changes. 4.Patients who required Oxygen therapy to maintain saturation during admission.

Nitesh Das consider him negative after such an asymptomatic period.

Kawsar Uddin sir new guideline hishabe corona negative howar criteria ki? Covid positive(mild) with asthma kotodin rivaroxaben continue kora uchit after 7 days enoxaparin? Covid positive(mild symptoms) without co morbidity kotodin rivaroxaben continue kora uchit after 3 days enoxaparin

Kawsar Uddin sir will u plz?

Afroja Akhter it’s normal, don't worry. No need of anticoagulant, just take care.

Kawsar Uddin thanks..

Sultana Jebunnaher ১. ৩ সপ্তাহ সাধারণত, কারো কারো ক্ষেত্রে mild symptoms ও weakness আরো কয়েক সপ্তাহ থাকতে পারে, It's variable. ২. no role. ৩. nothing, search for other causes, like musculoskeletal pain, GERD, IHD, etc.

Kawsar Uddin she is only 18 yrs.

Asim Saha 4 weeks at least, and monitoring thereafter, further decisions will be accordingly.

Kawsar Uddin thanks

Mita Rahman it’s variable depends on certain factors and monitoring.

Anita Ahmed যেহেতু কয়েকটি risk factors আছে, সাথে বয়সটাকেও বিবেচনায় আনতে হবে, তাই anticoagulant দেয়াটা logical, আর এক্ষেত্রে dose adjust করতে d dimer হেল্প করবে। ১০ দিন যেহেতু পার হয়েছে without any unwanted consequences, সেহেতু খারাপ কিছু হওয়ার আর সম্ভাবনা কম, তবুও বয়স বিবেচনায় করে দেখাটাই ভাল।

M K Chy symptomatic সকল রোগী -

আব্দুল্যাহ আল মাসুম আমার নিজের অল্প কাঁশি এবং সামান্য জ্বর ( ১০১ এর বেশি নয় ) ছিলো ৪ দিন । D dimer দরকার কি? কোন রিস্ক ফ্যাক্টর নেই। বয়স ৫২,৫৩।

M K Chy কতদিন আগে পজিটিভ?

আব্দুল্যাহ আল মাসুম ১৭ দিন আগে।

M K Chy no need -

according to 7th version of national guideline D-dimer is asked for COVID severe cases but in other form of COVID clinical scenario will guide for early requisition of D-dimer.

M K Chy স্যার সবার করানোটাই যৌক্তিক। তবে moderate to severe case এ অবশ্যই, আর যাদের risk factors আছে, hospitalized case. আপনার যেহেতু 2 wks পার হয়ে গেছে এখন আর প্রয়োজন নেই।

Israt Sumonta no, need monitoring, as there are some evidenced significant adverse effects.

Upama Saha then clinical eye judgement.

Yasmin Sultana provoked thrombo embolism jehetu so 3 month.....rivaroxaban dile....ccr level o check korte hobe

Tarek Hasan rivaroxavan koto mg kore dite hobe?

Munira Islam 2.5 mg bd starting dose.....

Munira Islam according to American society of haematology....tara 10 mg daily for 31 to 39 days recommend koreche.....

Tobe jodi associated af or valvular disease thake tahole 20 mg once daily......ar ccr 30 to 49 hole 15 mg once daily r ccr 30 ar kom hole contraindicated

Amitesh Das usually for weeks, 4-6 weeks or more, depends on follow up d-dimer, when it fails to rise due to his residual disease process. Total procedure must be with great care to avoid any unwanted event.

Amitesh Das bro as it is a provoked thromboembolism so 3 month ideally and then review......

d dimer কয়দিন পর পর চেক করতে হবে?

M K Chy স্যার, কিছু flu like illness হতে পারে। কারণ IgA চেষ্টা করে initial defence দিতে, তখন কিছু symptoms হতেও পারে, আবার নাও পারে নির্ভর করে তার immunological response হতে কতটুকু সময় লাগবে।

Kawsar Uddin এত অল্প সময়ের মধ্যে কি সে আবার সংক্রমন হবে?

Sultana Jebunnaher আমিই তো ভিকটিম।

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Shakhawat Hossain Kawsar He will take it for 4 weeks.

Kawsar Uddin via clopidogrel ki sathe khete parbe

Shakhawat Hossain Kawsar other than stenting we usually prefer aspirin for IHD in this situation with anticoagulant instead of clopidogrel. But as it is single antiplatelet you can continue it with anticoagulant with careful monitoring.

Raju Arian vai

Tariq Jamil Opu Triple therapy ( aspirin , clopidogrel, oral anticoagulant) dea hoy bishesh condition e like stenting with AF. Eikhetre Jodio bleeding risk ache, risk benefit dekhe dea jete pare.... rivaroxaban 30-40 days .

Raju Arian vaiya... Vester mr, nidocard, renola soho baki oshud gulo ki cholbe?

Eder moddhe Ranolazine er Sathe rivaroxaban er drug interaction ache...... Moxifloxacin er satheo Ranolazine er interaction ache... consulting physician will decide this.

Raju Arian vaiya.. Rivarox na diye LMWH dile to kono jhamela hobe na.. I think

Raju Arian moxibac dose duration ses. Rivarox ta cholse via ki interaction hote pare renolazine plus rivarox

Pls continue prescribed drugs... Certainly drugs have been prescribed thinking risk benefit ratio. Interactions are potential risk.... But we will always think of risk benefit ratio.

Uni to akhon basay ty ask korlam