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Practice Guideline
. 2020 Aug-Sep;67(7):391-399.
doi: 10.1016/j.redar.2020.05.007. Epub 2020 May 23.

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

[Article in English, Spanish]
J V Llau  1 , R Ferrandis  2 , P Sierra  3 , F Hidalgo  4 , C Cassinello  5 , A Gómez-Luque  6 , M Quintana  7 , R Amezaga  8 , M Gero  9 , A Serrano  10 , P Marcos  11
Affiliations
Practice Guideline

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

[Article in English, Spanish]
J V Llau et al. Rev Esp Anestesiol Reanim (Engl Ed). 2020 Aug-Sep.

Abstract
in English, Spanish

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.

La infección por el coronavirus SARS-CoV-2, causante de la enfermedad denominada COVID-19, provoca alteraciones fundamentalmente en el sistema respiratorio. En los pacientes graves, con frecuencia la enfermedad evoluciona a un síndrome de distrés respiratorio agudo que puede predisponer a los pacientes a un estado de hipercoagulabilidad, con trombosis tanto a nivel venoso como arterial. Esta predisposición presenta una fisiopatología multifactorial, relacionada tanto con la hipoxia como con el grave proceso inflamatorio ligado a esta patología, además de los factores trombóticos adicionales presentes en muchos de los pacientes.

Ante la necesidad de optimizar el manejo de la hipercoagulabilidad, los grupos de trabajo de las Sociedades Científicas de Anestesiología-Reanimación y Terapéutica del Dolor (SEDAR) y de Medicina Intensiva, Crítica y de Unidades Coronarias (SEMICYUC), han desarrollado un consenso para establecer unas pautas de actuación frente a las alteraciones de la hemostasia observadas en los pacientes graves con infección por COVID-19. Estas recomendaciones incluyen la profilaxis de la enfermedad tromboembólica venosa en pacientes graves y en el periparto, el manejo de los pacientes en tratamiento crónico con fármacos antiagregantes o anticoagulantes, de las complicaciones hemorrágicas en la evolución de la enfermedad y de la interpretación de las alteraciones generales de la hemostasia.

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.

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Figures

Figure 1
Figure 1
Outline of thromboprophylaxis and management of anticoagulant and antiplatelet drugs in patients with COVID-19 infection. ASA: acetylsalicylic acid; AF: atrial fibrillation; AVK: antivitamin K; DD: d-dimer; DOA: direct oral anticoagulant; FIB: fibrinogen; GFR: glomerular filtration rate; HIT: heparin-induced thrombocytopaenia; IMV: invasive mechanical ventilation; LMWH: low molecular weight heparin; NR: normal range; NIMV: non-invasive mechanical ventilation; UFH: unfractionated heparin; VTE: venous thromboembolism.
See this image and copyright information in PMC

References

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