RESUMO
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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.
Assuntos
Humanos , Masculino , Feminino , Adulto , SARS-CoV-2 , COVID-19 , Embolia e Trombose , Consenso , AnticoagulantesRESUMO
Objetivo: Determinar si la anemia preoperatoria en los pacientes que son llevados a cirugía cardiovascular se asocia al aumento de la mortalidad, falla renal, accidentes cerebovasculares y eventos cardiovasculares cuando se comparan sus casos con los de pacientes con niveles de hemoglobina normales en el preoperatorio. Métodos: Se realizó una revisión sistemática y un metaanálisis de los estudios observacionales de cohorte y de casos y controles que exploraron la asociación entre los niveles de hemoglobina prequirúrgica y los desenlaces adversos de los pacientes sometidos a cirugía cardiovascular. Se consultaron las bases de datos MEDLINE, EMBASE y COCHRANE hasta la semana 50 de 2010; de manera independiente, fueron seleccionados los estudios que cumplieron con los criterios de inclusión. Se evaluaron las fuentes de heterogeneidad entre los estudios, como el sesgo de publicación. Resultados: De los estudios revisados se identificaron 260; entre dichos estudios, de 11 se pudieron extraer los datos suficientes para combinar el desenlace de mortalidad. De esos estudios, 6 se ajustaron por severidad y comorbilidades, mientras que en los restantes sus resultados no fueron ajustados; aun así se observó un incremento en el riesgo de mortalidad cuando se considera la anemia como variable independiente. Conclusiones: Los pacientes anémicos sometidos a cirugía cardiaca tienen un mayor riesgo de sufrir eventos adversos postoperatorios. Varios factores más también limitan la interpretación de los datos, incluyendo la falta de una definición uniforme de la anemia y la carencia de estudios expresamente diseñados para cuantificar la prevalencia y el impacto de la anemia en pacientes con enfermedades cardiovasculares.
Objective: To determine whether preoperative anemia in patients undergoing cardiovascular surgery is associated with higher mortality, renal failure, cerebrovascular accidents and cardiovascular events as compared to patients with normal preoperative levels of hemoglobin. Methods: A systematic review and a meta-analysis of the cohort observational and of cases and control studies was conducted, exploring the association between the pre-surgical levels of hemoglobin and adverse outcomes in patients undergoing cardiovascular surgery. The MEDLINE, EMBASE, and COCHRANE data-bases up to the 50th week of 2010 were consulted. The studies that complied with the inclusion criteria were independently selected. The sources of heterogeneity among the studies were assessed, including publication bias. Results: Of the total number of studies reviewed, 260 were identified; sufficient data could be extracted from 11 of them to combine the mortality outcome. Out of these studies, 6 were adjusted for severity and comorbidities, while the results of the remaining ones were not adjusted. Conclusions: Anemic patients undergoing cardiac surgery have a higher risk of postoperative adverse events. There are several factors limiting the interpretation of the data, including a poor standardized definition of anemia, and the lack of studies explicitly designed to quantify the prevalence and the impact of anemia in patients with cardiovascular diseases.