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2020, Número 4

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Rev Hematol Mex 2020; 21 (4)


Estrategias de anticoagulación en pacientes con COVID-19

Jiménez-Soto R, Montiel-Romero S, Neme-Yunes Y, Demichelis-Gómez MR, Inclán-Alarcón SI

Idioma: Español
Referencias bibliográficas: 55
Paginas: 210-224
Archivo PDF: 428.72 Kb.


RESUMEN

La enfermedad por SARS-CoV-2 (COVID-19) es una enfermedad emergente de interés global. La fisiopatología, el espectro de la manifestación y las complicaciones no están completamente descritas, entre las que destaca la coagulopatía con fenotipo protrombótico asociada con mal pronóstico. Existen diversos mecanismos implicados, como inflamación excesiva, hipoxemia, inmovilización y coagulación intravascular diseminada, entre otros. Al ser un trastorno vascular, la anticoagulación es un punto clave en el tratamiento; sin embargo, en la actualidad no existe evidencia suficiente para establecer un estándar de tratamiento para el manejo de la anticoagulación en estos pacientes. Este artículo es una revisión narrativa de la bibliografía que incluye 55 trabajos de revisión. Se emiten recomendaciones de manejo de coagulopatía asociada con COVID-19 en distintos escenarios basadas en evidencia: anticoagulación profiláctica estándar, profiláctica intermedia o terapéutica durante la hospitalización, al egreso, en manejo ambulatorio y otras condiciones especiales. En la actualidad carecemos de ensayos clínicos prospectivos que evalúen estos escenarios en COVID-19. Se recomienda que todos los pacientes con criterios de ingreso por esta enfermedad reciban anticoagulación profiláctica y valorar un esquema más intensivo de acuerdo con una estrategia individualizada y dinámica.


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