High Prevalence of Acquired Thrombophilia Without Prognosis Value in Patients With Coronavirus Disease 2019.
High Prevalence of Acquired Thrombophilia Without Prognosis Value in Patients With Coronavirus Disease 2019.
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DOI：
10.1161/jaha.120.017773
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发表时间：
2020-11-03
影响因子：
5.4
通讯作者：
Toulon P
中科院分区：
文献类型：
--
作者：
Ferrari E;Sartre B;Squara F;Contenti J;Occelli C;Lemoel F;Levraut J;Doyen D;Dellamonica J;Mondain V;Chirio D;Risso K;Cua E;Orban JC;Ichai C;Labbaoui M;Mossaz B;Moceri P;Appert-Flory A;Fischer F;Toulon P
最近的文献报道，因 2019 年冠状病毒病 (COVID-19) 感染而住院的患者有强烈的血栓形成倾向。这一特征很不寻常，似乎是 COVID-19 感染所特有的，尤其是重症感染。病毒感染可引发获得性血栓形成倾向，进而导致血栓并发症。我们调查是否存在可能参与这种现象的获得性血栓形成倾向，并报告其患病率。我们还想知道这些血栓形成倾向是否与严重 COVID-19 感染的不良预后有关。在连续 89 名因 COVID-19 感染住院的患者中，我们发现 PS（蛋白 S）缺乏症的患病率高达 20%，并且抗磷脂抗体（主要是狼疮抗凝物）的患病率很高（即 72%）。 PS 缺乏或抗磷脂抗体的存在与延长的活化部分凝血活酶时间无关，也与 D-二聚体、纤维蛋白原或 CRP（C 反应蛋白）浓度无关。这些凝血异常也与住院期间发生的血栓临床事件或死亡率无关。我们评估了检测 COVID-19 感染者血栓形成倾向的阳性检测的高患病率。然而，在我们的系列中，这些获得性血栓形成倾向与疾病的严重程度和血栓事件的发生均不相关。尽管COVID-19感染有很强的血栓倾向，但频繁获得性血栓形成倾向的存在可能是COVID-19炎症风暴的一部分，不应该系统地修改我们的预防性抗凝治疗策略，在这种病理情况下，该策略已经向上修订。网址：https://www.clinicaltriials.gov；唯一标识符：NCT04335162。
Recent literature reports a strong thrombotic tendency in patients hospitalized for a coronavirus disease 2019 (COVID‐19) infection. This characteristic is unusual and seems specific to COVID‐19 infections, especially in their severe form. Viral infections can trigger acquired thrombophilia, which can then lead to thrombotic complications. We investigate for the presence of acquired thrombophilia, which could participate in this phenomenon, and report its prevalence. We also wonder if these thrombophilias participate in the bad prognosis of severe COVID‐19 infections. In 89 consecutive patients hospitalized for COVID‐19 infection, we found a 20% prevalence of PS (protein S) deficiency and a high (ie, 72%) prevalence of antiphospholipid antibodies: mainly lupus anticoagulant. The presence of PS deficiency or antiphospholipid antibodies was not linked with a prolonged activated partial thromboplastin time nor with D‐dimer, fibrinogen, or CRP (C‐reactive protein) concentrations. These coagulation abnormalities are also not linked with thrombotic clinical events occurring during hospitalization nor with mortality. We assess a high prevalence of positive tests detecting thrombophilia in COVID‐19 infections. However, in our series, these acquired thrombophilias are not correlated with the severity of the disease nor with the occurrence of thrombotic events. Albeit the strong thrombotic tendency in COVID‐19 infections, the presence of frequent acquired thrombophilia may be part of the inflammation storm of COVID‐19 and should not systematically modify our strategy on prophylactic anticoagulant treatment, which is already revised upwards in this pathological condition. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04335162.