Problemas de coagulação em adultos com síndroma respiratório agudo grave devido a infeção por coronavírus 2 (SARS-CoV-2): uma revisão abrangente

Autores

  • Susana Pereira Costa USF Travessa da Saúde ACeS Loures-Odivelas ARS Lisboa e Vale do Tejo http://orcid.org/0000-0001-8734-7354
  • Inês Lopes Antunes USF Travessa da Saúde ACeS Loures-Odivelas ARS Lisboa e Vale do Tejo
  • Ana Margarida Gomes USF Travessa da Saúde ACeS Loures-Odivelas ARS Lisboa e Vale do Tejo
  • Cláudia Ho USF Travessa da Saúde ACeS Loures-Odivelas ARS Lisboa e Vale do Tejo
  • Mafalda Lemos Caldas USF Travessa da Saúde ACeS Loures-Odivelas ARS Lisboa e Vale do Tejo
  • Ana Rute Marques USF Travessa da Saúde ACeS Loures-Odivelas ARS Lisboa e Vale do Tejo
  • Ana Monteiro Pereira USF Travessa da Saúde ACeS Loures-Odivelas ARS Lisboa e Vale do Tejo http://orcid.org/0000-0002-0495-9230
  • Ana Teresa Peres USF Travessa da Saúde ACeS Loures-Odivelas ARS Lisboa e Vale do Tejo
  • Gema Ponce Revilla USF Travessa da Saúde ACeS Loures-Odivelas ARS Lisboa e Vale do Tejo
  • Inês Vidreiro USF Travessa da Saúde ACeS Loures-Odivelas ARS Lisboa e Vale do Tejo

DOI:

https://doi.org/10.32385/rpmgf.v37i5.13086

Palavras-chave:

Vírus da SARS, Coagulopatias, Anticoagulantes, Inibidores da agregação de plaquetas, Revisão

Resumo

Objetivos: Resumir as informações publicadas acerca dos problemas de coagulação em adultos com SARS-CoV-2, incluindo características, fisiopatologia, diagnóstico e resposta ao uso profilático ou terapêutico de anticoagulantes ou antiagregantes plaquetários.

Métodos: Realizada uma revisão abrangente, de acordo com as guidelines Joanna Briggs Institute Guidelines on Scoping Reviews e Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines (PRISMA-ScR). Efetuada pesquisa nas bases de dados MEDLINE®, SciELO® e Web of Science® entre 1 e 2 de maio de 2020. A seleção dos artigos foi dividida em etapas sequenciais considerando: título, resumo e artigo integral. Em cada etapa os artigos foram aceites ou rejeitados tendo em conta os critérios de inclusão e exclusão. Foi feito o mapeamento dos dados e a evidência relevante foi sumarizada. 

Resultados: Após seleção obtiveram-se 106 artigos. Destes, 36 correspondiam a cartas, 28 a estudos originais, 25 a revisões e 14 a relatos de caso; uma meta-análise, um comentário e um consenso também foram incluídos. Os resultados mostraram associação entre COVID-19 e complicações trombóticas, embora com diferentes tipos de eventos e taxas de frequência. A tríade inflamação, disfunção endotelial e coagulopatia parecem estar subjacentes às alterações fisiopatológicas. As técnicas laboratoriais e de imagem podem ser úteis para uma intervenção adequada. A profilaxia com anticoagulantes parentéricos, preferencialmente heparina de baixo peso molecular (HBPM) em dose intermédia, entre as comummente utilizadas para profilaxia ou tratamento, está indicada em pacientes hospitalizados, especialmente com doença grave. Deve ser mantida por um período variável após a alta, dependendo do doente. A anticoagulação terapêutica parece não diferir de outras situações previamente conhecidas.

Conclusões: Várias incertezas persistem na abordagem dos problemas da coagulação em pacientes com infeção por SARS-CoV-2. As informações existentes dizem respeito principalmente ao contexto hospitalar e têm origem em fontes pouco robustas. Assim, são necessários ensaios clínicos aleatorizados e controlados para sustentar as decisões clínicas em todos os estadios.

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2021-11-08

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Pereira Costa, S., Lopes Antunes, I., Gomes, A. M., Ho, C., Lemos Caldas, M., Marques, A. R., Monteiro Pereira, A., Peres, A. T., Ponce Revilla, G., & Vidreiro, I. (2021). Problemas de coagulação em adultos com síndroma respiratório agudo grave devido a infeção por coronavírus 2 (SARS-CoV-2): uma revisão abrangente. Revista Portuguesa De Medicina Geral E Familiar, 37(5), 421–434. https://doi.org/10.32385/rpmgf.v37i5.13086