ABSTRACT
Background: During the COVID-19 pandemic, guideline documents on the management of anticoagulation were rapidly published. However, these documents did not follow a structured methodology, and significant differences existed between the guidelines. The aim of this expert consensus was to provide recommendations on the clinical management of oral anticoagulation in patients in the context of the COVID-19 pandemic. Methods: A two-round Delphi study was conducted using an online survey. In the first round, panellists expressed their level of agreement with the items on a 9-point Likert scale. Items were selected if they received approval from ≥66.6% of panellists and if they were agreed by the scientific committee. In the second round, panellists revaluated those items that did not meet consensus in the first round. Results: A total of 147 panellists completed the first round, and 144 of them completed the second round. Consensus was reached on 161 items included in five dimensions. These dimensions addressed: (I) management of anticoagulation in patients with atrial fibrillation (AF) without mechanical valves or moderate/severe mitral stenosis during COVID-19 infection; (II) thromboprophylaxis in patients hospitalised for COVID-19; (III) management of anticoagulation at hospital discharge/after COVID-19; (IV) anticoagulation monitoring in the COVID-19 pandemic setting; and (V) role of telemedicine in the management and follow-up of patients with AF in the COVID-19 pandemic setting. Conclusions: These areas of collective agreement could specially guide clinicians in making decisions regarding anticoagulation in patients with COVID-19 during hospitalisation and at discharge, where results from clinical trials are still limited and, in some cases, conflicting.
ABSTRACT
Type 2 diabetes (T2DM) is one of the main public health care problems worldwide. It is associated with a marked increased risk of developing atherosclerotic vascular disease, heart failure, chronic kidney disease and death. It is essential to act during the early phases of the disease, through the intensification of lifestyle changes and the prescription of those drugs that have been shown to reduce these complications, with the aim not only of achieving an adequate metabolic control, but also a comprehensive vascular risk control. In this consensus document, developed by the different specialists that treat these patients (endocrinologists, primary care physicians, internists, nephrologists and cardiologists), a more appropriate approach in the management of patients with T2DM or its complications is provided. A particular focus is given to the global control of cardiovascular risk factors, the inclusion of weight within the therapeutic objectives, the education of patients, the deprescription of those drugs without cardiovascular benefit, and the inclusion of GLP-1 receptor agonists and SGLT2 inhibitors as cardiovascular protective drugs, at the same level as statins, acetylsalicylic acid, or renin angiotensin system inhibitors.
ABSTRACT
El tratamiento hipolipemiante es uno de los pilares de la prevención cardiovascular; en la prevención secundaria de pacientes con cardiopatía isquémica, es una de las estrategias de mayor eficacia, pero el tratamiento hipolipemiante actual, junto con cambios en el estilo de vida, en una importante proporción de pacientes no consigue alcanzar los objetivos recomendados por las guías de práctica clínica. Los inhibidores PCSK9 han mostrado eficacia y seguridad en el tratamiento de la dislipemia y se han incorporado recientemente en España para empleo clínico con el objetivo de reducir el riesgo cardiovascular debido a su efecto en la reducción del colesterol unido a lipoproteínas de baja densidad (AU)
Lipid-lowering therapy is one of the cornerstones of cardiovascular prevention and is one of the most effective strategies in the secondary prevention of ischemic heart disease. Nevertheless, the current treatment of lipid disorders, together with lifestyle changes, fails to achieve the targets recommended in clinical guidelines in a substantial proportion of patients. PCSK9 inhibitors have demonstrated safety and efficacy in the treatment of dyslipidemia. Due to their ability to reduce low-density lipoprotein cholesterol levels, these drugs have recently been approved for clinical use by Spanish regulatory agencies, with the aim of reducing cardiovascular risk in selected patient groups (AU)
Subject(s)
Humans , Hypolipidemic Agents/therapeutic use , Hyperlipidemias/drug therapy , Coronary Disease/complications , Antibodies, Monoclonal/therapeutic use , Needs Assessment , Hyperlipidemias/epidemiology , Practice Patterns, Physicians' , SubtilisinABSTRACT
Lipid-lowering therapy is one of the cornerstones of cardiovascular prevention and is one of the most effective strategies in the secondary prevention of ischemic heart disease. Nevertheless, the current treatment of lipid disorders, together with lifestyle changes, fails to achieve the targets recommended in clinical guidelines in a substantial proportion of patients. PCSK9 inhibitors have demonstrated safety and efficacy in the treatment of dyslipidemia. Due to their ability to reduce low-density lipoprotein cholesterol levels, these drugs have recently been approved for clinical use by Spanish regulatory agencies, with the aim of reducing cardiovascular risk in selected patient groups.
Subject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hyperlipidemias/drug therapy , Hyperlipoproteinemia Type II/drug therapy , Hypolipidemic Agents/therapeutic use , PCSK9 Inhibitors , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Cardiology , Cholesterol, LDL/blood , Humans , Hyperlipidemias/blood , Hyperlipoproteinemia Type II/blood , Patient Care Planning , Primary Prevention , Secondary Prevention , Societies, Medical , SpainABSTRACT
No disponible
Subject(s)
Humans , Cardiovascular Diseases/prevention & control , Primary Prevention/methods , Rehabilitation/methods , Risk Factors , Nutrition Therapy/methods , Exercise Movement Techniques , Exercise Therapy/methods , Tobacco Use CessationSubject(s)
Cardiac Rehabilitation , Cardiovascular Diseases/epidemiology , Diabetes Mellitus/epidemiology , Diet Therapy , Dyslipidemias/epidemiology , Exercise , Hypertension/epidemiology , Smoking/epidemiology , Cardiovascular Diseases/prevention & control , Diabetes Mellitus/therapy , Diet, Mediterranean , Dyslipidemias/therapy , Humans , Hypertension/therapy , Risk Reduction Behavior , Smoking/therapy , Smoking CessationSubject(s)
Body Mass Index , Endothelium, Vascular/physiology , Inflammation/blood , Age Factors , HumansABSTRACT
No disponible
