1. PICO Questions and DELPHI Methodology for the Management of Venous Thromboembolism Associated with COVID-19
- Author
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Riera-Mestre, Antoni, Jara-Palomares, Luis, Lecumberri, Ramón, Trujillo-Santos, Javier, Grau, Enric, Blanco-Molina, Angeles, Carbonell, Ana Piera, Jiménez, Sonia, Vargas, Manuel Frías, Fuset, Mari, Bellmunt-Montoya, Sergi, Monreal, Manuel, Jiménez, David, Project, on behalf of the COVILAX, Institut Català de la Salut, [Riera-Mestre A] Internal Medicine Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain. Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain. [Jara-Palomares L] Medical-Surgical Unit for Respiratory Diseases, Virgen del Rocío University Hospital, Sevilla, Spain. Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. [Lecumberri R] Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain. Center for Biomedical Research Network on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain. [Trujillo-Santos J] Internal Medicine Department, Hospital General Universitario Santa Lucía, Cartagena, Spain. Faculty of Health Sciences, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain. [Grau E] Hematology Department, Lluis Alcanyis de Xativa Hospital, Valencia, Spain. [Blanco-Molina A] Internal Medicine Unit, Hospital Universitario Reina Sofía, Córdoba, Spain. [Bellmunt-Montoya S] Servei de Angiologia, Cirurgia Vascular i Endovascular, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Departament de Cirurgia, Universitat Autònoma de Barcelona, Bellaterra, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
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pulmonary embolism ,Delphi Technique ,Coronaviruses ,Deep vein ,Delphi method ,coronavirus ,law.invention ,law ,virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES] ,Medicine ,Trombosi ,enfermedades cardiovasculares::enfermedades vasculares::embolia y trombosis::tromboembolia::tromboembolia venosa [ENFERMEDADES] ,anticoagulation ,COVID-19 (Malaltia) - Complicacions ,Embòlia pulmonar ,Cardiovascular Diseases::Vascular Diseases::Embolism and Thrombosis::Thromboembolism::Venous Thromboembolism [DISEASES] ,Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES] ,Venous Thromboembolism ,Medicina clínica - Presa de decisions ,Intensive care unit ,Thrombosis ,QR1-502 ,Pulmonary embolism ,Ciencias de la información::análisis de sistemas::técnica Delfos [CIENCIA DE LA INFORMACIÓN] ,Infectious Diseases ,medicine.anatomical_structure ,Information Science::Systems Analysis::Delphi Technique [INFORMATION SCIENCE] ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,medicine.drug_class ,Low molecular weight heparin ,Microbiology ,Article ,deep vein thrombosis ,Virology ,Humans ,Intensive care medicine ,Tromboembolisme ,Duration of Therapy ,business.industry ,fungi ,Anticoagulants ,COVID-19 ,Heparin, Low-Molecular-Weight ,medicine.disease ,Coronavirus ,Embolism ,business ,venous thromboembolic disease - Abstract
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.
- Published
- 2021
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