Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine
Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine
复制标题
DOI：
10.1055/s-0040-1715798
复制
发表时间：
2020-09-13
影响因子：
6.7
通讯作者：
Zhai, Zhenguo
中科院分区：
文献类型：
--
作者：
Gerotziafas, Grigoris T.;Catalano, Mariella;Zhai, Zhenguo
COVID-19还表现为高凝状态、肺血管内凝血、微血管病和静脉血栓栓塞（VTE）或动脉血栓形成。严重COVID-19的易感风险因素是男性、基础心血管疾病或心血管风险因素，包括未控制的糖尿病或动脉高血压、肥胖和高龄。VAS-欧洲血管病学/血管医学独立基金会提请注意血管疾病（VD）患者，并提出了一项综合策略，用于管理VD或心血管风险因素（VD-CVR）和COVID-19患者。VAS建议（1）为VD-CVR患者建立以COVID-19为导向的初级卫生保健网络，以识别社区中的VD-CVR患者，并对患者进行疾病症状教育，使用电子健康技术，坚持抗血栓和血管调节治疗，（2）密切的医疗跟进-在出现新的流行病浪潮时，我们会采取有效措施控制性病的发展，并迅速采取身体和社交距离措施。对于接受COVID-19家庭治疗的VD-CVR患者，VAS建议评估（1）高风险患者的疾病恶化风险和优先住院治疗，以及（2）高风险患者的VTE风险评估和利伐沙班、贝曲沙班或低分子量肝素（LMWH）血栓预防。对于VD-CVR和COVID-19住院患者，VAS建议（1）常规血栓预防，使用体重调整的中等剂量LMWH（除非禁忌症）;（2）LMWH作为治疗VTE或高凝状态的首选药物，而不是普通肝素或直接口服抗凝剂;（3）仔细评估疾病恶化的风险，并及时应用靶向抗病毒或恢复治疗;（4）监测D-二聚体以优化抗血栓治疗;和（5）使用IMPROVE-D-二聚体评分和使用利伐沙班、贝曲沙班或LMWH延长的出院后血栓预防来评估出院前VTE的风险。
COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH.