Complicaciones arteriales trombóticas en pacientes hospitalizados con COVID-19

Rey, J.; Caro‐Codón, Juan; Pineda, Dolores Poveda; Merino, José Luís; Iniesta, Ángel M.; López‐Sendón, José

doi:10.1016/j.recesp.2020.05.013

Cited by 37 publications

(11 citation statements)

References 7 publications

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“…However, Rey et al reported a series of cases of acute arterial thrombosis in March 2020 and found that the cohort of patients who were SARS-CoV-2 positive had significantly higher inflammatory markers, higher mortality, and higher proportion of multiple thrombosis events. 22 Also of note, approximately 10% of the patients in this review were reportedly on vasopressors, making this a less likely confounding variable. Additionally, one study found an increase in limb ischemia cases when comparing the number of vascular surgery consults from JanuaryeMarch in 2020 vs 2019, 4 but this finding was not uniform.…”

Section: Discussionmentioning

confidence: 92%

SARS-CoV-2 and limb ischemia: A systematic review

Putko

Bedrin

Clark

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background: Recent spread of severe acute respiratory coronavirus syndrome-2 (SARS-CoV-2) has led to the coronavirus disease (COVID-19) pandemic, resulting in new challenges across all medical specialties. Limb and digit ischemia have been associated with COVID-19 infection. This systematic review includes primary studies of COVID-19 limb ischemia to identify risk factors, comorbidities, case characteristics, and treatment strategies to better understand the nature of this disease and its effects on the extremities. Methods: A literature search for studies detailing COVID-19 infected patients with limb or digit ischemia was performed, identifying 157 articles, 12 of which met inclusion criteria, accounting for 47 patients. Inclusion criteria were (1) primary studies, (2) positive disease diagnosis (3) limb ischemia, (4) reported treatment. Demographic data, case characteristics, treatments, outcomes and mortality were collected and pooled. Results: The average patient age was 67.6 years, predominantly male (79.6%). Of the 44 cases discussing treatment, 13 (30%) patients underwent medical treatment alone, while 23 (52.3%) patients underwent medical plus surgical treatment. Four patients (9.1%) were treated with observation. In 10 of the 12 studies, lab findings, thrombosis, or conclusions supporting a hypercoagulable state as a cause of limb/ digit ischemia were cited. Five patients (10.6%) were on vasopressors and 8 patients (17.0%) were on a ventilator. Of those treated with observation alone, there was 100% resolution of symptoms. Of those treated medically without surgical intervention (17 patients), 6 patients (35.3%) were reported to have revascularization, 6 patients (35.3%) died, and the remaining outcomes were not reported. Medical and surgical treatment resulted in one limb amputation (4.4%) and altogether 74% of patients achieved revascularization of the affected limb/digit. Mortality rate was 45%. Conclusions: COVID-19 infection may be associated with increased risk of limb or digital ischemia, although the quality of evidence supporting this theory is limited. Evidence of inflammatory-mediated thrombosis and endothelial injury are possible explanations which would support the use of immunotherapy in addition to anticoagulation for treatment or prevention of thromboembolic events. Current outcomes and treatment strategies are variable. Level of evidence: IV.

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Section: Discussionmentioning

confidence: 92%

SARS-CoV-2 and limb ischemia: A systematic review

Putko

Bedrin

Clark

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…Lippi et al encontraron que los niveles elevados de dímero D en la COVID-19, en el 59.6%, se asoció con mayor severidad de la enfermedad (D > 0.5 microgramos/ml en enfermedad grave), e identificaron la trombocitopenia como marcador de gravedad y muerte en el 4-57%, y como de mal pronóstico, el aumento inicial y después la disminución del fibrinógeno en los que no sobreviven 33,34 .…”

Section: Discussionunclassified

Frecuencia de trombosis arteriales y venosas de las extremidades en pacientes con COVID-19

Velasco-Vázquez¹,

Bizueto-Rosas²,

Morales-Montoya³

et al. 2022

RMA

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Antecedentes: La infección respiratoria COVID-19, es un factor de riesgo para trombosis arteriales y/o venosas de las extremidades. Objetivo: Determinar la frecuencia de trombosis arteriales o venosas por COVID-19. Método: Estudio de cohorte retrospectivo para determinar la incidencia de trombosis por COVID-19 y comorbilidades asociadas; utilizamos para el análisis estadístico el programa SPSS-25, estableciendo significancia estadística una p < 0.05. Resultados: Valoramos por probable patología vascular, a 255 pacientes en la unidad COVID-19; 49% (n = 125 pacientes), cumplió con los criterios de inclusión; 90.4% (n = 113) presentó algún grado de IAA; 12% (n = 15) TVP; 3.2% (n = 4) trombosis arterial y venosa. Resultaron ser factores de riesgo para TVP ser mujer, y para IAA ser hombre y tener diabetes mellitus tipo 2. Conclusiones: En la trombosis arterial o venosa influyó el género, incrementándose el riesgo con

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“…La infección por SARS-CoV-2, denominada COVID-19, induce un estado protrombótico, con generación de trombos y fibrina que se deposita en la microcirculación, caracterizado por la elevación del fibrinógeno y dímeros-D. La hipoxemia grave secundaria a infección por SARS-CoV-2 se debe fundamentalmente a microtrombosis difusa y disfunción endotelial de la circulación pulmonar. 1 Por lo tanto, la COVID-19 predispone a una incidencia aumentada de eventos trombóticos agudos, arteriales y venosos. De tal modo, múltiples consensos publicados proponen la tromboprofilaxis con heparinas de bajo peso molecular (HBPM) como primera opción, en ausencia de contraindicaciones, en todo paciente que requiere ingreso hospitalario por COVID-19, si bien para la Organización Mundial de la Salud (OMS) es una recomendación condicional con bajo nivel de evidencia.…”

Section: Respuesta Carta Al Editorunclassified

“…La enfermedad grave por SARS-CoV-2 se asocia a alteraciones evidentes de la hemostasia representadas principalmente por fenómenos trombóticos que pueden presentarse en todos los lechos vasculares. (1,2) En el Hospital Universitario 12 de Octubre durante los meses de marzo y abril de 2020 (el pico más alto de infección en Madrid) fueron atendidos 2.943 pacientes confirmados con COVID-19. De ellos, 106 pacientes presentaron procesos trombóticos vasculares (arteriales o venosos) sintomáticos; 11 pacientes presentaron trombosis vasculares múltiples en diferentes territorios y de diferente naturaleza.…”

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¿Puede ser el policosanol un arma contra la COVID-19?

2021

Rev. urug. med. interna

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Complicaciones arteriales trombóticas en pacientes hospitalizados con COVID-19

Cited by 37 publications

References 7 publications

SARS-CoV-2 and limb ischemia: A systematic review

SARS-CoV-2 and limb ischemia: A systematic review

Frecuencia de trombosis arteriales y venosas de las extremidades en pacientes con COVID-19

¿Puede ser el policosanol un arma contra la COVID-19?

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