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Efecto de la anticoagulación sobre la mortalidad en COVID 19 severa y crítica: una revisión sistemática con metaanálisis
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Autores
Buitrago Cadena, Andrea Carolina
Noches Buelvas, Andrea Carolina
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Fecha
2023-11-30
Directores
Molina Castaño, Carlos Federico
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Universidad del Rosario
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Resumen
La infección por SARS CoV2 y la pandemia mundial resultante han significado un desafío para la humanidad desde todos los puntos de vista. La COVID-19 no solamente se asocia a hipoxemia, insuficiencia respiratoria y síndrome de dificultad respiratoria aguda (SDRA), sino también a un estado protrombótico, que puede manifestarse como trombosis microvascular y macrovascular (venosa o arterial), que se asocia a peores desenlaces incluyendo la muerte, así como las complicaciones a largo plazo, resultantes del daño orgánico irreversible. Objetivos. Determinar la efectividad de la anticoagulación plena vs tromboprofilaxis en la reducción de mortalidad, disfunción orgánica, oxigenación, eventos trombóticos y sangrado mayor en adultos mayores de 18 años con COVID-19 hospitalizados.
Abstract
The SARS-CoV-2 infection and the resulting global pandemic have posed a challenge for humanity from all perspectives. On the public health front, it has been a colossal challenge. Millions of cases have been diagnosed worldwide since the description of COVID-19 and its manifestations. COVID-19 is not only associated with hypoxemia, respiratory failure, and acute respiratory distress syndrome (ARDS) but also with a prothrombotic state, leading to microvascular and macrovascular thrombosis (venous or arterial). This is associated with worse outcomes, including death, as well as long-term complications resulting from irreversible organ damage. Objectives. To determine the effectiveness of full anticoagulation vs thromboprophylaxis in reducing mortality, organ dysfunction, oxygenation, thrombotic events, and major bleeding in adults aged 18 and older hospitalized with COVID-19. Search Strategy. The search was conducted in selected databases: Cochrane, Embase, Web of Science, Clinical Key, Pubmed/MEDLINE, Clinical Trials - Springer Link. For grey literature, Google, Google Scholar, university repositories, ClinicalTrials.gov, OPENGRAY were utilized. The following terms were used for the search: "COVID-19," "anticoagulants," "hospitalization," "intensive care units," "respiratory insufficiency," "multiple organ failure," "clinical trial." Filters for publication years, language, methodological designs, and participant types were applied in these databases. Selection Criteria. Randomized clinical trials published between June 1, 2020, and October 31, 2022, including adults aged 18 and older with COVID-19 (confirmed SARS-CoV-2 infection through antigen, IgM, IgG antibodies, or RT-PCR according to the current diagnostic algorithm of the National Institute of Health). Participants should have been hospitalized in general wards or critical care and received the evaluated interventions.
Palabras clave
Anticoagulación , Tromboprofilaxis , COVID-19 severa , COVID-19 crítica , Falla ventilatoria , Disfunción orgánica , Mortalidad
Keywords
Anticoagulation , Thromboprophylaxis , Severe COVID-19 , Critical COVID-19 , Ventilatory failure , Organ dysfunction , Mortality
