Watson Ryan A, Johnson Drew M, Dharia Robin N, Merli Geno J, Doherty John U
Division of Cardiology, Department of Medicine, At Thomas Jefferson University Hospital, Sidney Kimmel Medical College , Philadelphia, PA, USA.
Division of Cerebrovascular Disease, Department of Neurology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College , Philadelphia, PA, USA.
Hosp Pract (1995). 2020 Oct;48(4):169-179. doi: 10.1080/21548331.2020.1772639. Epub 2020 Jun 9.
The coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged health-care systems and physicians worldwide to attempt to provide the best care to their patients with an evolving understanding of this unique pathogen. This disease and its worldwide impact have sparked tremendous interest in the epidemiology, pathogenesis, and clinical consequences of COVID-19. This accumulating body of evidence has centered around case series and often empiric therapies as controlled trials are just getting underway. What is clear is that patients appear to be at higher risk for thrombotic disease states including acute coronary syndrome (ACS), venous thromboembolism (VTE) such as deep vein thrombosis (DVT) or pulmonary embolism (PE), or stroke. Patients with underlying cardiovascular disease are also at higher risk for morbidity and mortality if infected. These patients are commonly treated with anticoagulation and/or antiplatelet medications and less commonly thrombolysis during hospitalization, potentially with great benefit but the management of these medications can be difficult in potentially critically ill patients. In an effort to align practice patterns across a large health system (Jefferson Health 2,622 staffed inpatient beds and 319 intensive care unit (ICU) beds across 14 facilities), a task force was assembled to address the utilization of anti-thrombotic and anti-platelet therapy in COVID-19 positive or suspected patients. The task force incorporated experts in Cardiology, Vascular Medicine, Hematology, Vascular Surgery, Pharmacy, and Vascular Neurology. Current guidelines, consensus documents, and policy documents from specialty organizations were used to formulate health system recommendations.
Our goal is to provide guidance to the utilization of antithrombotic and antiplatelet therapies in patients with known or suspected COVID-19.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）大流行，对全球医疗系统和医生构成了挑战，他们需要在对这种独特病原体的认识不断发展的情况下，努力为患者提供最佳治疗。这种疾病及其全球影响引发了人们对COVID-19流行病学、发病机制和临床后果的极大兴趣。随着对照试验刚刚开始，这些不断积累的证据主要围绕病例系列以及通常的经验性治疗。显而易见的是，患者出现血栓性疾病状态的风险更高，包括急性冠状动脉综合征（ACS）、静脉血栓栓塞（VTE），如深静脉血栓形成（DVT）或肺栓塞（PE），或中风。患有基础心血管疾病的患者如果感染，发病和死亡风险也更高。这些患者在住院期间通常接受抗凝和/或抗血小板药物治疗，较少接受溶栓治疗，可能会有很大益处，但在可能病情危急的患者中，这些药物的管理可能很困难。为了使一个大型医疗系统（杰斐逊医疗集团，在14个医疗机构共有2622张配备医护人员的住院床位和319张重症监护病房（ICU）床位）的诊疗模式保持一致，成立了一个特别工作组，以解决COVID-19阳性或疑似患者抗血栓和抗血小板治疗的使用问题。该特别工作组纳入了心脏病学、血管医学、血液学、血管外科、药学和血管神经病学领域的专家。利用专业组织的现行指南、共识文件和政策文件来制定医疗系统建议。
我们的目标是为已知或疑似COVID-19患者抗血栓和抗血小板治疗的使用提供指导。
