SEDAR-SEMICYUC consensus recommendations on the management of haemostasis disorders in severely ill patients with COVID-19 infection

J V Llau, R Ferrandis, P Sierra, F Hidalgo, C Cassinello, A Gómez-Luque, M Quintana, R Amezaga, M Gero, A Serrano, P Marcos, J V Llau, R Ferrandis, P Sierra, F Hidalgo, C Cassinello, A Gómez-Luque, M Quintana, R Amezaga, M Gero, A Serrano, P Marcos

Abstract

The infection by the coronavirus SARS-CoV-2, which causes the disease called COVID-19, mainly causes alterations in the respiratory system. In severely ill patients, the disease often evolves into an acute respiratory distress syndrome that can predispose patients to a state of hypercoagulability, with thrombosis at both venous and arterial levels. This predisposition presents a multifactorial physiopathology, related to hypoxia as well as to the severe inflammatory process linked to this pathology, including the additional thrombotic factors present in many of the patients. In view of the need to optimise the management of hypercoagulability, the working groups of the Scientific Societies of Anaesthesiology-Resuscitation and Pain Therapy (SEDAR) and of Intensive, Critical Care Medicine and Coronary Units (SEMICYUC) have developed a consensus to establish guidelines for actions to be taken against alterations in haemostasis observed in severely ill patients with COVID-19. These recommendations include prophylaxis of venous thromboembolic disease in these patients, and in the peripartum, management of patients on long-term antiplatelet or anticoagulant treatment, bleeding complications in the course of the disease, and the interpretation of general alterations in haemostasis.

Keywords: Anti-platelets; Anticoagulantes; Anticoagulants; Antitrombóticos; COVID-19; Complicaciones del embarazo; Coronavirus infections; Heparina de bajo peso molecular; Infecciones por coronavirus; Low-molecular-weight heparin; Pregnancy complications; Thrombosis; Trombosis.

Copyright © 2020. Publicado por Elsevier España, S.L.U.

Figures

Figura 1
Figura 1
Esquema resumido de la tromboprofilaxis y el manejo de los fármacos anticoagulantes y antiagregantes en los pacientes con infección por COVID-19. AAS: ácido acetilsalicílico; ACOD: anticoagulante oral directo; AVK: antivitamina K; DD: dímero D; ETEV: enfermedad tromboembólica venosa; FA: fibrilación auricular; FG: filtrado glomerular; FIB: fibrinógeno; HBPM: heparina de bajo peso molecular; HNF: heparina no fraccionada; RN: rango de normalidad; TIH: trombocitopenia inducida por heparina; VMI: ventilación mecánica invasiva; VMNI: ventilación mecánica no invasiva.

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