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      COVID-19: potential role of prophylactic anticoagulation in preventing thrombotic events and mortality. Narrative review

      review-article
      ,
      Iberoamerican Journal of Medicine
      Hospital San Pedro
      COVID-19, SARS-CoV-2, Thrombosis, Anticoagulation

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          Abstract

          Abstract The COVID-19 pandemic and the limited therapeutic arsenal available strain daily clinical practice. Guidelines have recently recommended routine anticoagulation of hospitalized COVID-19 patients. However, apart from the expert panels' experience, the provenance of this recommendation is not clear, due to the scarce published evidence. We provide a narrative review with the objective of unraveling the rationale for this practice. First, we analyze the biochemical, histopathological and clinical evidence for a pro-thrombotic profile in COVID-19 patients. Then, we present the clinical data from previous studies and discuss to what extent they aid in clinical decision-making. We conclude that, in the absence of randomized controlled trials, which are of utmost importance, prophylactic-dose anticoagulation should be offered to critically ill patients hospitalized for COVID-19 pneumonia, particularly those with high d-dimer levels, since they are the population most likely to benefit from it.

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          Most cited references37

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            A Novel Coronavirus from Patients with Pneumonia in China, 2019

            Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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              Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

              In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
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                Author and article information

                Journal
                ijm
                Iberoamerican Journal of Medicine
                Iberoam J Med
                Hospital San Pedro (Logroño, La Rioja, Spain )
                2695-5075
                2695-5075
                2021
                : 3
                : 2
                : 122-129
                Affiliations
                [1] Santa Fe orgnameJB Iturraspe Hospital Argentina
                Article
                S2695-50752021000200006 S2695-5075(21)00300200006
                10.5281/zenodo.4554351
                6a8090ef-f3ab-4c04-8826-388d08a83982

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 25 January 2021
                : 19 February 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 37, Pages: 8
                Product

                SciELO Spain

                Categories
                Review

                SARS-CoV-2,Thrombosis,Anticoagulation,COVID-19
                SARS-CoV-2, Thrombosis, Anticoagulation, COVID-19

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