Manejo de hemorragia digestiva y anticoagulación en tiempos de COVID - 19

Digestive bleeding and anticoagulation management in times of COVID - 19

Palabras clave: Sangrado gastrointestinal, COVID-19, anticoagulación

Resumen

El sangrado gastrointestinal (SGI) en pacientes con SARS-CoV-2 plantea desafíos únicos. Aunque los resultados de ensayos controlados para demostrar el beneficio de la anticoagulación empírica están pendientes, los centros médicos han propuesto la anticoagulación en dosis intermedia y terapéutica, particularmente aquellos con niveles elevados de dímero D, con el fin de prevenir complicaciones tromboembólicas potencialmente catastróficas. En pacientes con hemorragia digestiva se recomienda iniciar medidas de reanimación, Inhibidor de bomba de protones, transfusiones de hemoderivados y retirada de anticoagulantes. En sospecha de hemorragia relacionada con hipertensión portal, se recomienda tratar de acuerdo con las pautas estándar: reanimación, fármacos vasoconstrictores  esplácnico, concentrados de glóbulos rojos para mantener una hemoglobina objetivo de 7 a 8 g/dL, inhibidor de la bomba de protones administrado en forma de perfusión o inyecciones dos veces al día, antibióticos como profilaxis primaria, Vitamina K, antifibrinolíticos y retirada de los anticoagulantes. Igualmente se sugiere estricto seguimiento hemodinámico para cualquier evidencia de sangrado persistente.

Citas

The Lancet. Emerging understandings of 2019-nCoV.The Lancet 2020;395:311.

Pan L, Mu M, Yang P, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China. Am J Gastroenterol 2020; 1 (http://journals.lww.com/10.14309/ajg.0000000000000620).

Luo S, Zhang X, Xu H. Don’t overlook digestive symptoms in patients with 2019 novel coronavirus disease (COVID-19). Clin Gastroenterol Hepatol 2020;18(7):1636–7.

NobelYR, Phipps M, Zucker J, et al. Gastrointestinal symptoms andCOVID-19: Case-control study from the United States. Gastroenterology (http://www.ncbi.nlm.nih.gov/pubmed/32294477). (2020). Accessed April 19, 2020.

Parita Patel, Neil Sengupta. PPIs and Beyond: A Framework for Managing Anticoagulation‑Related Gastrointestinal Bleeding in the Era of COVID‑19. Digestive Diseases and Sciences (2020) 65:2181–2186

Becker RC. COVID-19 update: Covid-19-associated coagulopa-t hy. J Thromb Thrombolysis. 2020. https ://doi.org/10.1007/s11239-020-02134 -3.

Barrett CD, Moore HB, Yaffe MB, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19: a comment. J Thromb Haemost. 2020. https ://doi.org/10.1111/jth.14860 .

Barnes GD, Burnett A, Allen A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis. 2020. https ://doi.org/10.1007/s1123 9-020-02138 –z.

Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel corona-virus pneumonia. J Thromb Haemost. 2020;18:844–847

Han H, Yang L, Liu R, et al. Prominent changes in blood coagula-tion of patients with SARS-CoV-2 infection. Clin Chem Lab Med.2020. https ://doi.org/10.1515/cclm-2020-0188.

Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062.

Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;135:2033–2040

Yin S, Huang M, Li D, et al. Difference of coagulation fea-tures between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2. J Thromb Thrombolysis. 2020. https ://doi.org/10.1007/s1123 9-020-02105 -8.

Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up. J Am Coll Cardiol. 2020;75:2950–2973.

Hylek EM, Evans-Molina C, Shea C, et al. Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation. 2007;115:2689–2696.

Hansen ML, Sørensen R, Clausen MT, et al. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med. 2010;170:1433–1441.

Schelleman H, Brensinger CM, Bilker WB, et al. Antidepressant-warfarin interaction and associated gastrointestinal bleeding risk in a case-control study. PLoS ONE. 2011;6:e21447.

Franchis R de. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015; 63:743–52.
Publicado
2021-05-04
Cómo citar
Dias De Oliveira, C. M. (2021). Manejo de hemorragia digestiva y anticoagulación en tiempos de COVID - 19: Digestive bleeding and anticoagulation management in times of COVID - 19. Revista Profesional HígadoSano, (20), 16-19. Recuperado a partir de https://produccioncientificaluz.org/index.php/higadosano/article/view/35798
Sección
Artículos