Management of patients on antithrombotic therapy with severe infections: a joint clinical consensus statement of the ESC Working Group on Thrombosis, the ESC Working Group on Atherosclerosis and Vascular Biology, and the International Society on Thrombosis and Haemostasis
Por:
Gigante, B, Levy, JH, van Gorp, E, Bartoloni, A, Bochaton-Piallat, ML, Back, M, ten Cate, H, Christersson, C, Ferreiro, JL, Geisler, T, Lutgens, E, Schulman, S, Storey, RF, Thachil, J, Vilahur, G, Liaw, PC, Rocca, B
Publicada:
22 ago 2023
Ahead of Print:
1 jul 2023
Resumen:
Patients with severe infections and a pre-existing indication for antithrombotic therapy, i.e. antiplatelet agents, anticoagulant drugs, or their combinations, require integrated clinical counselling among coagulation, infectious disease, and cardiology specialists, due to sepsis-induced coagulopathy that frequently occurs. Bacterial and viral pathogens constitute an increasing threat to global public health, especially for patients with ongoing antithrombotic treatment who have a high risk of thrombotic recurrences and high susceptibility to severe infections with increased morbidity and mortality. Similarly, sepsis survivors are at increased risk for major vascular events. Coagulopathy, which often complicates severe infections, is associated with a high mortality and obligates clinicians to adjust antithrombotic drug type and dosing to avoid bleeding while preventing thrombotic complications. This clinical consensus statement reviews the best available evidence to provide expert opinion and statements on the management of patients hospitalized for severe bacterial or viral infections with a pre-existing indication for antithrombotic therapy (single or combined), in whom sepsis-induced coagulopathy is often observed. Balancing the risk of thrombosis and bleeding in these patients and preventing infections with vaccines, if available, are crucial to prevent events or improve outcomes and prognosis.
Filiaciones:
Gigante, B:
Karolinska Inst, Dept Med, Div Cardiovasc Med, Solnavagen 30, S-17164 Stockholm, Sweden
Danderyd Hosp, Dept Cardiol, Entrevagen 2, S-18288 Stockholm, Sweden
Levy, JH:
Duke Univ, Dept Anesthesiol, Sch Med, 2301 Erwin Rd, Durham, NC 27710 USA
Duke Univ, Dept Crit Care, Sch Med, 2301 Erwin Rd, Durham, NC 27710 USA
Duke Univ, Dept Surg Cardiothorac, Sch Med, 2301 Erwin Rd, Durham, NC 27710 USA
van Gorp, E:
Erasmus MC, Dept Virosci, POB 2040 Room Ee1726, NL-3000 CA Rotterdam, Netherlands
Bartoloni, A:
Univ Florence, Dept Expt & Clin Med, Infect Dis Unit, Largo Brambilla 3, I-50100 Florence, Italy
Bochaton-Piallat, ML:
Univ Geneva, Dept Pathol & Immunol, Fac Med, 1 Rue Michel Servet 1, CH-1211 Geneva, Switzerland
Back, M:
Karolinska Inst, Dept Translat Cardiol, CMM L8 01, S-17176 Stockholm, Sweden
Karolinska Univ Hosp, CMM L8 01, S-17176 Stockholm, Sweden
Univ Lorraine, Nancy Univ Hosp, INSERM U1116, 2 Rue Jean Lamour, F-54505 Vandoeuvre Les Nancy, France
ten Cate, H:
Maastricht Univ, Dept Internal Med, Thrombosis Expertise Ctr, Med Ctr, Univ Single 50,POB 616, NL-6200 MD Maastricht, Netherlands
CARIM Sch cardiovasc Dis, Univ Single 50,POB 616, NL-6200 MD Maastricht, Netherlands
Gutenberg Univ, Ctr Thrombosis & Haemostasis, Med Ctr, Langenbeckstr 1,Bldg 403, D-55131 Mainz, Germany
Christersson, C:
Uppsala Univ, Akad Sjukhuset, Dept Med Sci, Cardiol, S-75185 Uppsala, Sweden
Ferreiro, JL:
LHospitalet de Llobregat Hosp Duran & Reynals, Dept Cardiol, Edifici Terapeut 2a Planta Gran Via Hosp, Barcelona 08908, Spain
LHospitalet de Llobregat Hosp Duran & Reynals, Bioheart Cardiovasc Dis Res Grp, Edifici Terapeut 2a Planta Gran Via Hosp, Barcelona 08908, Spain
LHospitalet de Llobregat Hosp Duran & Reynals, Bellvitge Univ Hosp, Bellvitge Biomed Res Inst IDIBELL, Edifici Terapeut 2a Planta Gran Via Hosp, Barcelona 08908, Spain
LHospitalet de Llobregat Hosp Duran & Reynals, CIBERCV, Edifici Terapeut 2a Planta Gran Via Hosp, Barcelona 08908, Spain
Geisler, T:
Univ Tubingen Hosp, Dept Cardiol & Angiol, Otfried Muller Str 10, D-72076 Tubingen, Germany
Lutgens, E:
Mayo Clin, Cardiovasc Med, Expt CardioVasc Immunol Lab, 200 First St SW, Rochester, MN 55905 USA
Ludwig Maximilians Univ Munchen, Inst Cardiovasc Prevent IPEK, Pettenkoferstr 9, D-80336 Munich, Germany
German Ctr Cardiovasc Res DZHK, Partner Site Munich Heart Alliance, Pettenkoferstr 9, D-80336 Munich, Germany
Schulman, S:
McMaster Univ, Dept Med, HHS Gen Hosp, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
McMaster Univ, Thrombosis & Atherosclerosis Res Inst, HHS Gen Hosp, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
IM Sechenov First Moscow State Med Univ, Dept Obstet & Gynecol, Bolshaya Pirogovskaya Ulitsa 2,Crp 4, Moscow 119435, Russia
Storey, RF:
Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Pegasus House,463a Glossop Rd, Sheffield S10 2QD, England
Thachil, J:
Manchester Univ Hosp, Dept Haematol, Oxford Rd, Manchester M13 9WL, England
Vilahur, G:
Inst Recerca Hosp Santa Creu & St Pau, IIB Sant Pau, CIBERCV, Avda St Antoni Maria Claret 167, Barcelona 08025, Spain
Liaw, PC:
McMaster Univ, Dept Med, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
McMaster Univ, Thrombosis & Atherosclerosis Res Inst TaARI, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
Rocca, B:
Catholic Univ, Pharmacol Sect, Dept Safety & Bioeth, Sch Med, Largo F Vito 1, I-00168 Rome, Italy
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