Consenso Colombiano para la prevención, diagnóstico y manejo de condiciones trombóticas en pacientes adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE  <span class="so-article-trans-title" dir="auto"> Translated title: Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adult patients with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks </span>

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Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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

Fei Zhou, Ting Yu, Ronghui Du … (2020)

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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Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia

Ning Tang, Dengju Li, Xiong Wang … (2020)

Abstract Background In the recent outbreak of novel coronavirus infection in Wuhan, China, significantly abnormal coagulation parameters in severe novel coronavirus pneumonia (NCP) cases were a concern. Objectives To describe the coagulation feature of patients with NCP. Methods Conventional coagulation results and outcomes of 183 consecutive patients with confirmed NCP in Tongji hospital were retrospectively analyzed. Results The overall mortality was 11.5%, the non‐survivors revealed significantly higher D‐dimer and fibrin degradation product (FDP) levels, longer prothrombin time and activated partial thromboplastin time compared to survivors on admission (P < .05); 71.4% of non‐survivors and 0.6% survivors met the criteria of disseminated intravascular coagulation during their hospital stay. Conclusions The present study shows that abnormal coagulation results, especially markedly elevated D‐dimer and FDP are common in deaths with NCP.

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Author and article information

Journal

Journal ID (publisher-id): amc

Title: Acta Medica Colombiana

Abbreviated Title: Acta Med Colomb

Publisher: Asociacion Colombiana de Medicina Interna (Bogotá, Distrito Capital, Colombia )

ISSN (Print): 0120-2448

Publication date (Print and electronic): March 2021

Volume: 46

Issue: 1

Pages: 51-72

Affiliations

[2] Bogotá D.C. orgnameFundación Universitaria Sanitas Colombia

[22] orgnameSociedad Colombiana de Cardiología y Cirugía Cardiovascular Colombia

[10] Bogotá D.C. orgnameClínica Colsanitas Colombia

[21] Bogotá D.C. orgnameFundación Clínica Shaio Colombia

[15] Bogotá D.C. orgnameFundación Universitaria de Ciencias de la Salud Colombia

[5] Bogotá D.C. orgnameClínica Universitaria Colombia Colombia

[16] Bogotá orgnameUniversidad Nacional de Colombia Colombia

[17] Bogotá D.C. orgnameHospital Universitario Nacional de Colombia Colombia

[27] Bogotá D.C. orgnameHospital Universitario San Ignacio Colombia

[4] Bogotá D.C. orgnameClínica Reina Sofía Colombia

[24] Bogotá D.C. orgnameHospital Santa Clara Colombia

[18] orgnameAsociación Colombiana de Hematología y Oncología Colombia

[25] Santiago de Cali Valle del Cauca orgnameUniversidad del Valle Colombia

[14] Bucaramanga orgnameClínica Foscal Colombia

[6] orgnameAsociación Colombiana de Nefrología e Hipertensión Arterial Colombia

[19] Barranquilla orgnameClínica Iberoamérica Colombia

[20] Santiago de Cali orgnameClínica Sebastián de Belalcázar Colombia

[1] Bogotá D.C orgnameInstituto Global de Excelencia Clínica Keralty Colombia

[31] Santiago de Cali orgnameFundación Valle del Lili Colombia

[11] orgnameGrupo Cooperativo Latinoamericano de Hemostasia y Trombosis, CLAHT

[3] Bogotá D.C. orgnameEPS Sanitas Colombia

[32] orgnameFundación Internacional de Medicina Materno Fetal

[28] orgnameSanitas EPS Perú

[9] orgnameAsociación Colombiana de Neumología y Cirugía de Tórax Colombia

[26] Santiago de Cali orgnameUniversidad Libre Colombia

[29] orgnameSociedad Ecuatoriana de Cardiología Ecuador

[30] orgnameSociedad Colombiana de Medicina Familiar Colombia

[8] Bogotá D.C. orgnameClínica Los Nogales Colombia

[12] orgnameAsociación Colombiana de Medicina Crítica y Cuidado Intensivo Colombia

[7] orgnameAsociación Colombiana de Medicina Interna Colombia

[13] Bogotá D.C. orgnameColsanitas Colombia

[33] Bogotá D.C. orgnameClínica de Marly Colombia

[23] orgnameAsociación Colombiana de Especialistas en Medicina de Urgencias y Emergencias Colombia

Article

Publisher ID: S0120-24482021000100051 Publisher ID: S0120-2448(21)04600100051

DOI: 10.36104/amc.2021.2078

SO-VID: eeb1e118-2c68-4d21-a884-4d2f8775b482

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

History

Date accepted : 16 December 2020

Date received : 15 December 2020

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Figures: 0, Tables: 0, Equations: 0, References: 51, Pages: 22

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Novel Coronavirus Disease COVID-19

Most cited references 51

Clinical Characteristics of Coronavirus Disease 2019 in China

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

Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia

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