Protocolo diagnóstico y terapéutico de las complicaciones vasculares de la COVID-19

  1. García Sánchez, F. 1
  2. Martín Fernández, M. 1
  3. Barbero Allende, J.M. 1
  4. Sanz Moreno, J. 1
  1. 1 Servicio de Medicina Interna. Hospital Universitario Príncipe de Asturias. Universidad de Alcalá. Alcalá de Henares. Madrid. España
Journal:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Year of publication: 2022

Issue Title: Enfermedades infecciosas (VII)

Series: 13

Issue: 55

Pages: 3250-3255

Type: Article

More publications in: Medicine: Programa de Formación Médica Continuada Acreditado

Sustainable development goals

Abstract

The clinical spectrum of the disease caused by SARS-CoV-2 (COVID-19) is highly variable. It commonly has a mild or asymptomatic course. Around 15% to 20% of patients have lung involvement, which can progress to acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome, with marked alteration of the inflammatory and immune response. In these severe forms, there is an increased prevalence of vascular thrombotic complications which manifest as venous thromboembolism, acute arterial ischemia in the limbs, and, less frequently, myocardial involvement or cerebrovascular accident. The proposed pathogenic mechanisms include diffuse endothelial damage or endotheliitis, microvascular inflammation, cytokine release, hypercoagulability, and hypoxia. Early recognition of these complications is vital for improving the prognosis and survival of these patients.

Bibliographic References

  • Giannis D, Ziogas IA, Gianni P. Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol. 2020; 127:104362.
  • Guan W, Ni Z, Hu Y, Liang W, Ou C, He J. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382:1708-20.
  • Giannis D, Allen SL, Tsang J, Flint S, Pinhasov T, Williams S. Postdischarge thromboembolic outcomes and mortality of hospitalized patients with COVID-19: the CORE-19 registry. Blood. 2021;137:2838-47.
  • Fournier M, Faille D, Dossier A, Mageau A, Nicaise Roland P, Ajzenberg N. Arterial thrombotic events in adult inpatients with COVID-19. Mayo Clin Proc. 2021;96:295-303.
  • Indes JE, Koleilat I, Hatch AN, Choinski K, Jones DB, Aldailami H. Early experience with arterial thromboembolic complications in patients with COVID-19. J Vasc Surg. 73(2):381-9.
  • Guo T, Fan Y, Chen M, Wu X, Zhang L, He T. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019(COVID-19). JAMA Cardiol. 2020;5:811-8.
  • Baldini T, Asioli GM, Romoli M, Carvalho Dias M, Schulte EC, Hauer L. Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus-2 infection: A systematic review and meta-analysis. Eur J Neurol. 2021;28(10):3478-90.
  • Merkler AE, Parikh NS, Mir S, Gupta A, Kamel H, Lin E. Risk of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) vs patients with influenza. JAMA Neurol. 2020;77(11):1-7