RESUMEN
Coronavirus disease 2019 (COVID-19) has been associated with an increased risk of thromboembolic complications due to systemic coagulation activation. Little is known about the role of direct anticoagulants (DOACs) in COVID-19 related thrombosis. In this audit we sought to distinguish COVID-19 hospitalised patients with a diagnosis of venous thromboembolism (VTE) and record their outcomes over a period of 3 months (01/02/2020-30/04/2020). A total of 1583 patients were diagnosed with laboratory proven COVID-19 disease. Amongst them, 38 patients (0.82%) suffered VTE (median age 68 years, male/female: 20/18). VTE was the presenting symptom on admission in 71%. Pulmonary embolism was diagnosed in 92% of patients; 5 patients required intensive care and 3 underwent thrombolysis. 27 patients received initial treatment with unfractionated heparin/low molecular weight heparin (LMWH) while 10 were treated with direct anticoagulants (DOACs). After a median follow up of 25 days, 29 (76%) patients were alive while 5 were still hospitalised. Most patients (83%) were discharged on DOACs, no VTE recurrence or bleeding was recorded post-discharge. Our results suggest that direct anticoagulants could be a safe and effective treatment option in selected COVID-19 positive patients who have suffered venous thromboembolism.
Asunto(s)
Tratamiento Farmacológico de COVID-19 , COVID-19 , Inhibidores del Factor Xa/administración & dosificación , Heparina/administración & dosificación , Embolia Pulmonar , Tromboembolia Venosa , Cuidados Posteriores/estadística & datos numéricos , Anciano , COVID-19/sangre , COVID-19/complicaciones , COVID-19/epidemiología , Auditoría Clínica , Cuidados Críticos/métodos , Cuidados Críticos/estadística & datos numéricos , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Fibrinolíticos/administración & dosificación , Humanos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/etiología , SARS-CoV-2/aislamiento & purificación , Terapia Trombolítica/métodos , Terapia Trombolítica/estadística & datos numéricos , Reino Unido/epidemiología , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/tratamiento farmacológico , Tromboembolia Venosa/etiologíaRESUMEN
A key component of training in Acute Medicine is the assessment and initial resuscitation of severely ill medical patients. The curriculum for General Internal Medicine (Acute Medicine) states that all specialists in Acute Medicine should attain Level 3 competencies in all emergency presentations.1 Different training programmes have variable exposure to the emergency department, to which the majority of these patients present. One module, currently being developed at City Hospital, Birmingham, is for the Acute Medicine Specialist Registrars (SpRs) to attend all medical alerts in Accident and Emergency (A&E) Department. This means that the SpR works as part of the receiving team, seeing patients first hand, rather than taking secondary referrals. At our hospital over 80% of alerts brought in the resuscitation room are medical emergencies.
RESUMEN
Symptoms compatible with a transient ischaemic attack (TIA) are a common reason to seek medical attention. Most TIAs resolve within an hour and leave no residual symptoms or signs. This can make the diagnosis problematic, but perhaps more importantly, can lead both patient and doctor to underestimate the importance of the event, and the urgency with which it should be addressed. The risk of a subsequent stroke is high: around 8% after seven days and 17-18% after three months.1,2 This review aims to discuss some of the issues surrounding the investigation and management of TIAs, including the potential role of Acute Medicine in the provision of timely and appropriate management for these patients.