Anticoagulación en pacientes con infección por SARS-CoV-2/COVID-19

Abstract

espanolIntroduccion: el COVID-19 es una enfermedad infecciosa ocasionada por el virus RNA SARS-CoV-2, con una alta tasa de contagio y con un curso clinico heterogeneo. Existe evidencia que en fase avanzada de COVID-19 hay un riesgo aumentado de coagulacion intravascular diseminada. Por lo tanto, el manejo con heparinas debe ser considerado como una estrategia terapeutica. Objetivos: nuestro objetivo principal es mostrar la literatura mas relevante disponible, con referencia a la utilidad de la anticoagulacion en el manejo de la hipercoagulabilidad en los pacientes con COVID-19 graves. Metodologia: se realizo una revision narrativa a partir de la busqueda avanzada con los terminos DeSC: Infecciones por Coronavirus; SARS-CoV; Coagulacion Sanguinea; Coagulacion Intravascular Diseminada; Disfuncion organica multiple; Sepsis; Sindrome de respuesta inflamatoria sistemica; Lesion renal aguda. Se utilizaron los motores de busqueda Clinical Key, Embase, PubMed y Ovid, obteniendo un total de 143 resultados, entre articulos originales, reportes de casos, series de casos y revisiones de la literatura, se seleccionaron un total de 56 articulos que fueron utilizados para la elaboracion de la presente revision de tema. Conclusiones: el manejo con heparinas debe ser considerado como una estrategia terapeutica. Continuamos con la necesidad de futuros estudios que indaguen interrogantes en el paciente COVID-19 hospitalizado, especialmente que definan, evaluando riesgo/beneficio, que se justifica o no con respecto a la anticoagulacion plena en algunos pacientes especificos con COVID-19. EnglishIntroduction: COVID-19 is an infectious disease caused by the RNA SARS-CoV-2 virus, with a high rate of infection and a heterogeneous clinical course. There is evidence that in the advanced phase of COVID-19 there is an increased risk of disseminated intravascular coagulation. Therefore, heparin management should be considered as a therapeutic strategy. Objectives: our main objective is to show the most relevant literature available, with reference to the usefulness of anticoagulation in the management of hypercoagulability in patients with COVID-19 and severe manifestations. Methodology: A narrative review was performed from the advanced search with the terms DeSC: Coronavirus Infections; SARS-CoV; Blood Coagulation; Disseminated intravascular coagulation; Multiple organic dysfunction; Sepsis; Systemic inflammatory response syndrome; Acute kidney injury. The Clinical Key, Embase, PubMed and Ovid search engines were used, obtaining a total of 143 results, among original articles, case reports, case series and literature reviews, a total of 56 articles were selected that were used to the preparation of this topic review. Conclusions: Heparin management should be considered as a therapeutic strategy. We continue with the need for future studies that investigate questions in the hospitalized COVID-19 patient, especially defining, evaluating risk / benefit, which is justified or not with respect to full anticoagulation in some specific patients with COVID-19.