PICO Questions and DELPHI Methodology for the Management of Venous Thromboembolism Associated with COVID-19
Por:
Riera-Mestre, A, Jara-Palomares, L, Lecumberri, R, Trujillo-Santos, J, Grau, E, Blanco-Molina, A, Carbonell, AP, Jimenez, S, Vargas, MF, Fuset, MP, Bellmunt-Montoya, S, Monreal, M and Jimenez, D
Publicada:
1 nov 2021
Ahead of Print:
22 oct 2021
Resumen:
Patients with coronavirus disease 2019 (COVID-19) have a higher risk of venous thromboembolic disease (VTE) than patients with other infectious or inflammatory diseases, both as macrothrombosis (pulmonar embolism and deep vein thrombosis) or microthrombosis. However, the use of anticoagulation in this scenario remains controversial. This is a project that used DELPHI methodology to answer PICO questions related to anticoagulation in patients with COVID-19. The objective was to reach a consensus among multidisciplinary VTE experts providing answers to those PICO questions. Seven PICO questions regarding patients with COVID-19 responded with a broad consensus: 1. It is recommended to avoid pharmacological thromboprophylaxis in most COVID-19 patients not requiring hospital admission; 2. In most hospitalized patients for COVID-19 who are receiving oral anticoagulants before admission, it is recommended to replace them by low molecular weight heparin (LMWH) at therapeutic doses; 3. Thromboprophylaxis with LMWH at standard doses is suggested for COVID-19 patients admitted to a conventional hospital ward; 4. Standard-doses thromboprophylaxis with LMWH is recommended for COVID-19 patients requiring admission to Intensive Care Unit; 5. It is recommended not to determine D-Dimer levels routinely in COVID-19 hospitalized patients to select those in whom VTE should be suspected, or as a part of the diagnostic algorithm to rule out or confirm a VTE event; 6. It is recommended to discontinue pharmacological thromboprophylaxis at discharge in most patients hospitalized for COVID-19; 7. It is recommended to withdraw anticoagulant treatment after 3 months in most patients with a VTE event associated with COVID-19. The combination of PICO questions and DELPHI methodology provides a consensus on different recommendations for anticoagulation management in patients with COVID-19.
Filiaciones:
Riera-Mestre, A:
Bellvitge Biomed Res Inst IDIBELL, Hosp Univ Bellvitge, Dept Internal Med, Barcelona 08907, Spain
Univ Barcelona, Fac Med & Hlth Sci, Barcelona 08907, Spain
Jara-Palomares, L:
Virgen del Rocio Univ Hosp, Med Surg Unit Resp Dis, Seville 28029, Spain
Inst Salud Carlos III, Ctr Biomed Res Resp Dis Network CIBERES, Madrid 28029, Spain
Lecumberri, R:
Clin Univ Navarra, Dept Hematol, Pamplona 31008, Spain
Inst Salud Carlos III, Ctr Biomed Res Network Cardiovasc Dis CIBERCV, Madrid 28029, Spain
Trujillo-Santos, J:
Hosp Gen Univ Santa Lucia, Dept Internal Med, Cartagena 30204, Spain
Univ Catolica San Antonio Murcia UCAM, Fac Hlth Sci, Murcia 30107, Spain
Grau, E:
Lluis Alcanyis Xativa Hosp, Dept Hematol, Valencia 46800, Spain
Blanco-Molina, A:
Hosp Univ Reina, Internal Med Unit, Cordoba 10004, Spain
Carbonell, AP:
Luanco Hlth Ctr, Gozon 33440, Spain
Jimenez, S:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Emergency Area, Hosp Clin, Barcelona 08036, Spain
Vargas, MF:
Comillas Hlth Ctr, Madrid 28019, Spain
Fuset, MP:
Bellvitge Biomed Res Inst IDIBELL, Hosp Univ Bellvitge, Intens Med Dept, Barcelona 08907, Spain
Bellmunt-Montoya, S:
Hosp Univ Vall Hebron, Angiol & Vasc Surg Dept, Barcelona 08035, Spain
Univ Autonoma Barcelona, Dept Surg, Barcelona 08193, Spain
Vall Hebron Inst Recerca, Barcelona 08035, Spain
:
Univ Catolica San Antonio Murcia UCAM, Fac Hlth Sci, Murcia 30107, Spain
Germans Trias & Pujol Univ Hosp, Dept Internal Med, Badalona 08916, Spain
Jimenez, D:
Ramon & Cajal Hosp IRYCIS, Dept Pulmonol, Madrid 28034, Spain
Alcala Univ, Dept Med, Madrid 28805, Spain
Green Published, gold
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