A Delphi consensus on the management of anticoagulation in the COVID-19 pandemic: the MONACO study.

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular diagnosis and therapy Pub Date : 2023-10-31 Epub Date: 2023-10-25 DOI:10.21037/cdt-23-76
Carlos Escobar, Ramón Bover Freire, Xavier García-Moll Marimón, Carlos González-Juanatey, Miren Morillas, Alfonso Valle Muñoz, Juan José Gómez Doblas
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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.

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新冠肺炎大流行中抗凝治疗的德尔福共识:MONACO研究。
背景:在新冠肺炎大流行期间,有关抗凝治疗管理的指导文件迅速发表。然而,这些文件没有遵循结构化的方法,准则之间存在重大差异。本专家共识的目的是为新冠肺炎大流行背景下患者口服抗凝的临床管理提供建议。方法:采用在线调查法进行两轮德尔菲研究。在第一轮中,小组成员以9分的Likert量表表达了他们对这些项目的同意程度。如果项目获得了≥66.6%的小组成员的批准,并且获得了科学委员会的同意,则选择这些项目。在第二轮会议上,小组成员重新评估了第一轮会议上未达成共识的项目。结果:共有147名小组成员完成了第一轮,其中144人完成了第二轮。就五个方面的161个项目达成了共识。这些方面涉及:(I)新冠肺炎感染期间无机械瓣膜或中度/重度二尖瓣狭窄的心房颤动(AF)患者的抗凝治疗;(II) 新冠肺炎住院患者的血栓预防;(III) 出院/新冠肺炎后的抗凝管理;(IV) 新冠肺炎大流行环境中的抗凝监测;以及(V)远程医疗在新冠肺炎大流行环境中AF患者的管理和随访中的作用。结论:这些集体协议的领域可以特别指导临床医生在新冠肺炎患者住院和出院期间做出有关抗凝的决定,因为临床试验的结果仍然有限,在某些情况下甚至相互矛盾。
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来源期刊
Cardiovascular diagnosis and therapy
Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
4.20%
发文量
45
期刊介绍: The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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