ABSTRACT
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Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.
Subject(s)
Humans , Male , Female , Adult , SARS-CoV-2 , COVID-19 , Embolism and Thrombosis , Consensus , AnticoagulantsABSTRACT
Introducción: La fibrilación auricular se presenta como uno de los principales factores de riesgo para la presencia de eventos isquémicos cerebrales de origen cardioembólico, siendo cada vez mayor su prevalencia, especialmente por aumento de la edad poblacional. Este tipo de arritmia hace que sea necesario un tipo de prevención secundaria diferente a la realizada en otras patologías. Objetivo: Describir las características de los pacientes con ataque cerebrovascular isquémico (ACV) y su relación con fibrilación auricular. Materiales y métodos: Estudio descriptivo-retrospectivo de individuos con ACV isquémico. Se recolectó información sobre factores de riesgo para enfermedad cerebrovascular, presencia o no de fibrilación auricular y tratamiento recibido. Se realizaron tablas comparativas según la presencia o ausencia de fibrilación auricular. Se consideraron significativos los valores de p inferiores a 0,05. Resultados: Se incluyeron 246 pacientes con una mediana de edad de 71 años, la mitad de sexo masculino. Entre los factores de riesgo para ACV isquémico la prevalencia de hipertensión arterial (HTA) fue 73,9%, ACV previo 23,9%, tabaquismo previo 20,7%. La prevalencia de fibrilación auricular fue del 24,3%, siendo mayor en pacientes con falla cardiaca concomitante (OR 3,5 95%; IC 1,6-7,75; p = 0,000). Se observó menor probabilidad de fibrilación auricular entre los hombres (OR 0,49 95%; IC 0,26-0,92 p = 0,018). La dilatación de la aurícula izquierda estuvo presente en el 43,1% de los individuos con ACV isquémico. De quienes recibían anticoagulantes orales, 57% tenían fibrilación auricular. Solo 15% de los pacientes cumplieron criterios para realizar trombólisis. La mortalidad por cualquier causa en pacientes con ACV isquémico fue de 13,8% y en el grupo de fibrilación auricular del 16%. Conclusión: El ACV isquémico es una patología prevalente en nuestra población y aproximadamente uno de cada cinco pacientes con ACV presentan fibrilación ...
Introduction: Atrial fibrillation is presented as one of the main risk factors for the presence of stroke of cardioembolic origin. Its increasing prevalence is particularly caused by the aging population growth. This type of arrhythmia requires secondary prevention compared to the treatment of other illnesses. Objective: To describe the characteristics of ischemic stroke patients and its relationship with atrial fibrillation. Materials and methods: Retrospective descriptive study of individuals admitted with ischemic stroke. Information of risk factors for cerebrovascular disease, presence or abscense of atrial fibrillation and treatment received was collected. Comparative tables according to the presence or absence of atrial fibrillation were performed. Values less than 0.05 were considered significant. Results: There were 246 patients with ischemic stroke. The median of age was 71 years and half were male. The prevalence of risk factors for ischemic stroke were 73.9% for arterial hypertension (HT), 23.9% previous stroke, 20.7% for smoking. . The prevalence of atrial fibrillation was 24.3%, being higher in patients with concomitant heart failure (OR 3.5 95% CI 1.6 to 7.75 p = 0.000). There were lower probability of atrial fibrillation among men (OR 0.49 95% CI 0.26-0.92 p = 0.018). Dilatation of the left atrium was present in 43.1% ischemic stroke patients. 57% of the individuals who were taking oral anticoagulants had atrial fibrillation Only 15% met criteria for thrombolysis. The all-cause mortality in patients with ischemic stroke was 13.8% and in the atrial fibrillation group was 16%. Conclusion: Ischemic stroke is a prevalent disease in our population and nearly one in five patients with ischemic stroke have previous atrial fibrillation or de novo diagnosed during the event. The mortality in this subgroup of patients is 16%.
ABSTRACT
INTRODUCCIÓN: aunque la trombosis venosa cerebral representa una pequeña proporción de la enfermedad cere-brovascular, su incidencia y prevalencia se han incrementado en los últimos años. Este fenómeno se puede explicar por la mejoría en los métodos diagnósticos no invasivos y por el desarrollo de técnicas especializadas de resonancia magnética. Por las razones anteriores es necesario conocer las características demográficas y el comportamiento clínico de esta entidad en nuestro medio. OBJETIVO: describir las características clínicas y demográficas de pacientes con trombosis venosa cerebral y sus complicaciones en una población clínica de un hospital de IV nivel de Bogotá, Colombia y determinar los de factores de riesgo para complicaciones en la fase aguda. MATERIALES Y MÉTODOS: se analizaron historias clínicas de pacientes con trombosis venosa cerebral y se obtuvieron datos sobre aspectos demográficos, condición clínica y complicaciones. RESULTADOS: se encontraron 38 historias clínicas, 29 mujeres, 60,4% de ellas menores de 40 años. La trombofilia fue el factor de riesgo más común, con el síndrome antifosfolípido como causa principal, otras causas importantes fueron el embarazo y el puerperio. CONCLUSIÓN: la trombosis venosa cerebral es una enfermedad frecuente en la práctica clínica que afecta más a mujeres en edad fértil. Aunque no se encontró una relación estadísticamente significativa, las mujeres con síndrome antifosfolípido representaron el grupo con mayor riesgo de complicaciones. Se necesitan más estudios a futuro con una muestra de mayor tamaño.
INTRODUCTION: although cerebral venous thrombosis represents a small proportion of cerebrovascular disease, its incidence and prevalence has increased in recent years. This phenomenon can be explained by the improved access to noninvasive diagnostic methods and the development of more specialized techniques in magnetic resonance image (MRI). Also, it is convenient to know demographic and clinical aspects of this entity in our environment. OBJECTIVE: the aim of this study was to describe demographic and clinical features in patients with cerebral venous thrombosis and its complications in a cases series from a high complexity hospital in Bogotá, Colombia, and determine the association between risk factors and clinical complications in the acute phase. MATERIALS AND METHODS: clinical records belonging to patients with cerebral venous thrombosis were analyzed in order to obtain data regarding to demographic information, clinical condition and complications. RESULTS: 38 clinical records were analyzed, among which 76.3% were of female patients, 60.5% of which were under 40. Thrombophilia was the most frequent risk factor in which antiphospolipid syndrome represented the most common condition. Other important conditions were pregnancy and post partum period. CONCLUSION: cerebral venous thrombosis is frequent in clinical practice. In this cases series: female gender at childbearing age was the most affected group. Although we did not find statistical correlation, women with anti-phospolipid syndrome represented the group with most chance of complications. Further studies with a larger sample or big population are necessary.