Case Report: Case report: Administration of anticoagulant therapy after neuro-anesthesia procedure for hemorrhagic stroke patients with COVID-19 complications and its ethical and medicolegal consideration [version 2; peer review: 2 approved]
Background Ethical dilemmas can occur in any situation in clinical medicine. In patients undergoing neuro-anesthesia for surgical procedure evacuation of intracerebral hemorrhage with a history of hemorrhagic stroke, anticoagulants should not be given because they can cause recurrent bleeding. Meanw...
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| Format: | Article |
| Language: | English |
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F1000 Research Ltd
2023-12-01
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| Online Access: | https://f1000research.com/articles/10-1303/v2 |
| _version_ | 1797383041202520064 |
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| author | Taufik Suryadi Kulsum Kulsum |
| author_facet | Taufik Suryadi Kulsum Kulsum |
| author_sort | Taufik Suryadi |
| collection | DOAJ |
| description | Background Ethical dilemmas can occur in any situation in clinical medicine. In patients undergoing neuro-anesthesia for surgical procedure evacuation of intracerebral hemorrhage with a history of hemorrhagic stroke, anticoagulants should not be given because they can cause recurrent bleeding. Meanwhile, at the same time, the patient could also be infected with coronavirus disease 2019 (COVID-19), one of treatment is the administration of anticoagulants. Methods A case report. A 46-year-old male patient was admitted to hospital with a loss of consciousness and was diagnosed with intracerebral hemorrhage due to a hemorrhagic stroke and was confirmed positive for COVID-19. Giving anticoagulants to patients is considered counterproductive so, an ethical dilemma arises. For this reason, a joint conference was held to obtain the best ethical and medicolegal solutions for the patient. Results By using several methods of resolving ethical dilemmas such as basic ethical principles, supporting ethical principles, and medicolegal considerations, it was decided that the patient was not to be given anticoagulants. Conclusions Giving anticoagulants to hemorrhagic stroke patients is dangerous even though it is beneficial for COVID-19 patients, so here the principle of risk-benefit balance is applied to patients who prioritize risk prevention rather than providing benefits. This is also supported by the prima facie principle by prioritizing the principle of non-maleficence rather than beneficence, the minus malum principle by seeking the lowest risk, and the double effect principle by making the best decision even in a slightly less favorable way as well as the medicolegal aspect by assessing patient safety and risk management. |
| first_indexed | 2024-03-08T21:14:05Z |
| format | Article |
| id | doaj.art-2aaf1e1e1856471fbaf920927853932c |
| institution | Directory Open Access Journal |
| issn | 2046-1402 |
| language | English |
| last_indexed | 2024-03-08T21:14:05Z |
| publishDate | 2023-12-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | F1000Research |
| spelling | doaj.art-2aaf1e1e1856471fbaf920927853932c2023-12-22T01:00:01ZengF1000 Research LtdF1000Research2046-14022023-12-0110159891Case Report: Case report: Administration of anticoagulant therapy after neuro-anesthesia procedure for hemorrhagic stroke patients with COVID-19 complications and its ethical and medicolegal consideration [version 2; peer review: 2 approved]Taufik Suryadi0https://orcid.org/0000-0003-2069-7119Kulsum Kulsum1https://orcid.org/0000-0001-8171-6710Ethics and Medicolegal Consultant, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, IndonesiaNeuro-anesthesia and Critical Care Consultant, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, IndonesiaBackground Ethical dilemmas can occur in any situation in clinical medicine. In patients undergoing neuro-anesthesia for surgical procedure evacuation of intracerebral hemorrhage with a history of hemorrhagic stroke, anticoagulants should not be given because they can cause recurrent bleeding. Meanwhile, at the same time, the patient could also be infected with coronavirus disease 2019 (COVID-19), one of treatment is the administration of anticoagulants. Methods A case report. A 46-year-old male patient was admitted to hospital with a loss of consciousness and was diagnosed with intracerebral hemorrhage due to a hemorrhagic stroke and was confirmed positive for COVID-19. Giving anticoagulants to patients is considered counterproductive so, an ethical dilemma arises. For this reason, a joint conference was held to obtain the best ethical and medicolegal solutions for the patient. Results By using several methods of resolving ethical dilemmas such as basic ethical principles, supporting ethical principles, and medicolegal considerations, it was decided that the patient was not to be given anticoagulants. Conclusions Giving anticoagulants to hemorrhagic stroke patients is dangerous even though it is beneficial for COVID-19 patients, so here the principle of risk-benefit balance is applied to patients who prioritize risk prevention rather than providing benefits. This is also supported by the prima facie principle by prioritizing the principle of non-maleficence rather than beneficence, the minus malum principle by seeking the lowest risk, and the double effect principle by making the best decision even in a slightly less favorable way as well as the medicolegal aspect by assessing patient safety and risk management.https://f1000research.com/articles/10-1303/v2Anticoagulants COVID-19 Ethics and medicolegal Hemorrhagic stroke Neuro-anesthesiaeng |
| spellingShingle | Taufik Suryadi Kulsum Kulsum Case Report: Case report: Administration of anticoagulant therapy after neuro-anesthesia procedure for hemorrhagic stroke patients with COVID-19 complications and its ethical and medicolegal consideration [version 2; peer review: 2 approved] F1000Research Anticoagulants COVID-19 Ethics and medicolegal Hemorrhagic stroke Neuro-anesthesia eng |
| title | Case Report: Case report: Administration of anticoagulant therapy after neuro-anesthesia procedure for hemorrhagic stroke patients with COVID-19 complications and its ethical and medicolegal consideration [version 2; peer review: 2 approved] |
| title_full | Case Report: Case report: Administration of anticoagulant therapy after neuro-anesthesia procedure for hemorrhagic stroke patients with COVID-19 complications and its ethical and medicolegal consideration [version 2; peer review: 2 approved] |
| title_fullStr | Case Report: Case report: Administration of anticoagulant therapy after neuro-anesthesia procedure for hemorrhagic stroke patients with COVID-19 complications and its ethical and medicolegal consideration [version 2; peer review: 2 approved] |
| title_full_unstemmed | Case Report: Case report: Administration of anticoagulant therapy after neuro-anesthesia procedure for hemorrhagic stroke patients with COVID-19 complications and its ethical and medicolegal consideration [version 2; peer review: 2 approved] |
| title_short | Case Report: Case report: Administration of anticoagulant therapy after neuro-anesthesia procedure for hemorrhagic stroke patients with COVID-19 complications and its ethical and medicolegal consideration [version 2; peer review: 2 approved] |
| title_sort | case report case report administration of anticoagulant therapy after neuro anesthesia procedure for hemorrhagic stroke patients with covid 19 complications and its ethical and medicolegal consideration version 2 peer review 2 approved |
| topic | Anticoagulants COVID-19 Ethics and medicolegal Hemorrhagic stroke Neuro-anesthesia eng |
| url | https://f1000research.com/articles/10-1303/v2 |
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