ABSTRACT
BACKGROUND: Antithrombotic prophylaxis in hospitalised patients with SARS-CoV-2 acute infection has increased. Currently, most of the evidence relates to patients in intensive care units; however, there is little information on patients admitted to hospital wards and there is no consensus protocol on thromboprophylaxis during admission and after discharge. OBJECTIVE: To assess the effectiveness of antithrombotic prophylaxis in patients admitted with COVID-19 and 30 days after discharge. METHOD: A prospective observational study was conducted of patients admitted with COVID-19 in which the hospital thromboprophylaxis protocol was applied, classifying the patients as having a standard or high risk of thrombosis. Pharmacists performed a daily follow-up and actively intervened during admission and at discharge. The main outcome measure was the global incidence of symptomatic venous thromboembolism (VTE) related to hospitalisation. RESULTS: A total of 113 patients were included, 98.23% of whom were admitted to a hospital ward. The incidence of hospital-acquired VTE was 1.77%. In 75.22% of the subjects, thromboprophylaxis was adjusted to the protocol during admission. A total of 23 pharmaceutical interventions were conducted, with an adherence of 52.17%. At discharge, 94.28% of the patients who had no haemorrhage and ≥4 points on the Padua Prediction Score required thromboprophylaxis, aligning with the protocol. The global incidence of haemorrhagic events during the follow-up period was 0.88%. CONCLUSION: The incidence of hospital-acquired VTE was lower than that described in the literature. Although it cannot be certain that it is directly related to the instituted protocol, the data can show that the management of prevention of VTE is being optimally performed at the hospital. Long-term studies are needed to evaluate the incidence after discharge, as well as to agree on a specific protocol in the COVID-19 population for the prevention of these events during hospitalisation and post-discharge.
Subject(s)
COVID-19 , Venous Thromboembolism , Humans , Anticoagulants/therapeutic use , Patient Discharge , Fibrinolytic Agents/therapeutic use , Venous Thromboembolism/diagnosis , Venous Thromboembolism/epidemiology , Venous Thromboembolism/prevention & control , Aftercare , Risk Factors , COVID-19/complications , SARS-CoV-2ABSTRACT
La interacción fármaco-nutriente se define como una alteración de la cinética o dinámica de un medicamento o nutriente, y/o el deterioro del estado nutricional causado por la administración del fármaco. La cinética se refiere a la descripción cuantitativa de un medicamento o su disponibilidad, y la dinámica caracteriza el efecto clínico o fisiológico de la droga. Para la realización de esta revisión se han seleccionado y consultado un total de 21 artículos citados en la base de datos PubMed junto con los informes de diferentes guías de Sociedades Científicas españolas sobre práctica clínica relacionadas con dichas interacciones. En ellos se recogen diferentes tipos de interacciones y efectos negativos que se inducen tanto a nivel de la nutrición enteral (NE) como de la parenteral (NP). La disponibilidad de nutrientes puede verse afectada por el fármaco y el efecto terapéutico del fármaco puede ser modificado por el nutriente, incluido el riesgo de efectos adversos. Esta interacción se hace aún más relevante, cuando hablamos de soporte nutricional artificial, pues, los pacientes que requieren el uso de NE o NP, por lo general, no suelen estar sometidos exclusivamente a esa intervención médica, sino que solo es una parte más de su terapia farmacológica, aumentando el riesgo de interacciones y pudiendo ocasionar una pérdida de efectividad del tratamiento farmacológico, obstrucción de la sonda, incompatibilidad y desestabilización de la emulsión de NP, aparición de reacciones adversas o alteración del estado nutricional entre otros. Las consecuencias clínicas, derivadas de ello, dependerán del tipo de fármaco y de las características del paciente, siendo más susceptibles, los pacientes crónicos polimedicados, ancianos, y en estado crítico. Se concluye en la necesidad de conocer los principales tipos de interacciones, así como las técnicas de administración adecuadas, para ayudar a minimizar estas incompatibilidades y favorecer el éxito de una buena farmacoterapia
The drug-nutrient interaction is defined as an alteration of the kinetics and/or dynamics of a medicine or nutrient, and/or the deterioration of the nutritional status caused by the administration of the drug. Kinetics refers to the quantitative description of a drug or its availability, and the dynamics characterizes the clinical or physiological effects of the drug. In order to carry out this review, a total of 21 articles cited in the PubMed database were selected and consulted together with the reports of different Spanish Society Societies' guides on clinical practice related to these interactions.They contain different types of interactions and negative effects that are induced both at the level of enteral nutrition (EN) and parenteral (NP). Therefore, the availability of nutrients can be affected by the drug and the effect of the drug can be modified by the nutrient, including the risk of adverse effects. This interaction becomes even more relevant, when we speak of artificial nutritional support, therefore, patients that require the use of enteral or parenteral nutrition, in general, are not usually subjected exclusively to this medical intervention, but it is only one more part of their pharmacological therapy, increasing the risk of interactions and causing a loss of effectiveness of the pharmacological treatment, obstruction of the feeding tube, incompatibility and destabilization of the NP emulsion, appearance of adverse reactions or alteration of the nutritional status among others. The clinical consequences, derived from this, will depend on the type of drug and the characteristics of the patient, being more susceptible chronic polymedicated patients, elderly, and in critical conditions. In conclusion, it is essential to know the main types of interactions, as well as the appropriate administration techniques, to help minimize these incompatibilities and promote the success of good pharmacotherapy
