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Letter to the Editor
Approach to post-COVID-19 syndrome (PC19S): How long to maintain corticotherapy and heparin after discharge from intensive care?
Abordaje del síndrome post-COVID 19 (PC19S): ¿cuánto tiempo deben mantenerse la corticoterapia y la heparina tras el alta de cuidados intensivos?
José López Castro
Internal Medicine Dept. Hospital Público de Monforte, Lugo, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">SARS-CoV-2 is a pro-inflammatory and prothrombogenic virus with a high mutagenic profile&#44; which produces active infection of variable duration in various organs and systems<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> and it has been observed that patients who have already suffered from the disease&#44; especially in its more severe forms such as bilateral pneumonia or respiratory distress&#44; present symptoms and signs of chronic multiorganic involvement&#46; Given that there is a generalised chronic reactive endotheliitis with thrombosis markers &#40;<span class="elsevierStyleSmallCaps">d</span>-dimer&#44; von Willebrand Factor&#46;&#46;&#46;&#41; elevated in patients after discharge from Intensive care and which persists for weeks or even months&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2&#44;3</span></a> the possibility of chronic immunomodulatory treatment &#40;corticotherapy&#41; and anticoagulant treatment &#40;with low molecular weight heparin&#41; has been recommended in the medium term&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> without being able to specify a specific time frame but in the light of the available evidence it seems prudent for at least 6 months to 1 year&#44; evaluating clinical response every 2 months&#44; especially in those patients who have had a high viral load at the beginning of the disease and who have maintained it for more than 4 weeks&#44; since particularly in these patients&#44; similar conditions to residual pulmonary fibrosis &#40;up to 15&#37;&#41;&#44; neurological sequelae and even cases of fulminant myocarditis with a severe prognosis have been described&#46; Immunomodulatory treatment would decrease oxidative stress and fibroblast activator factor production&#44; thus minimizing global endothelial damage and especially at lung level&#44; having already been proven in animal models&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Although the virus has already been eliminated from the organism&#44; it can be demonstrated by repeated negative PCR&#44; the pro-inflammatory and prothrombotic state at the endothelial level in the microvasculature remains in some patients due to the formation of immune complexes&#44; generating a chronic reactive endothelitis with multiple vascular affectation&#44; preferably in the lungs &#40;up to 60&#37;&#41; and central nervous system &#40;up to 59&#8211;65&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> that ends up in the lungs in approximately 2 or 3 months in a picture that mimics a fibrotic interstitial pneumopathy clearly different from classic pulmonary fibrosis&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> conditioning an autoimmune hyperexcitability of the endothelium that remains after the acute clinical course of the disease and favours a progressive decrease in pulmonary compliance&#46; This results in an urgent need to research into whether the prolong immunomodulatory treatment &#40;corticotherapy&#41; and anticoagulant treatment &#40;low molecular weight heparin&#41; in the long term in patients who have suffered severe SARS-CoV-2 infection will improve the prognosis and decrease the sequelae of this disease&#46;</p></span>"
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Article information
ISSN: 0211139X
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos