Venous and arterial thrombosis in COVID-19: An updated narrative review.
Venous and arterial thrombosis in COVID-19: An updated narrative review.
复制标题
Covid-19中的静脉和动脉血栓形成：更新的叙述性评论。
DOI：
10.1016/j.jiph.2022.05.003
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发表时间：
2022-06
影响因子：
6.7
通讯作者：
Alhazzani, Waleed
中科院分区：
文献类型：
--
作者：
Al Duhailib, Zainab;Oczkowski, Simon;Polok, Kamil;Fronczek, Jakub;Szczeklik, Wojciech;Piticaru, Joshua;Mammen, Manoj J.;Alshamsi, Fayez;Eikelboom, John;Belley-Cote, Emilie;Alhazzani, Waleed
2019年冠状病毒病住院患者(新冠肺炎)，特别是那些住进重症监护病房的患者，发病率和死亡率都很高。一些观察性研究已经描述了新冠肺炎患者的止血紊乱和血栓并发症。本文就新冠肺炎的病理表现、病理生理、凝血和止血异常、D-二聚体在预测血栓性并发症的流行病学和危险因素中的作用，以及预防性和治疗性抗凝的作用等方面的研究进展作一综述。虽然现有证据的质量有限，但新冠肺炎似乎会增加住院和危重患者的微血管和大血管血栓发生率，这可能会增加疾病的负担。D-二聚体可用于住院患者的危险分层，但其指导抗凝治疗的作用尚不清楚。需要更高质量的证据来解决治疗性抗凝或高强度静脉血栓栓塞症预防在新冠肺炎患者中的作用。住院新冠肺炎患者静脉血栓栓塞症的患病率较高，因此，临床医生应有较高的怀疑指数。血栓形成的病理生理学机制可能与SARS-CoV-2直接损伤血管内皮细胞和引起凝血激活的炎症失调有关。目前关于D-二聚体引导治疗价值的证据是有限的。VTE的院后出院率非常低，支持目前大多数患者在没有预防VTE的情况下出院的安全性。更高强度的静脉血栓栓塞术预防或治疗性抗凝在无病历或疑似静脉血栓栓塞症的新冠肺炎危重患者中的作用仍不确定。住院的新冠肺炎非危重患者的抗凝治疗可能会改善预后，但更多的研究是有必要的。
Hospitalized patients with coronavirus disease 2019 (COVID-19), particularly those admitted to the intensive care unit (ICU) are at high risk of morbidity and mortality. Several observational studies have described hemostatic derangements and thrombotic complications in patients with COVID-19. The aim of this review article is to summarize the current evidence on pathologic findings, pathophysiology, coagulation and hemostatic abnormalities, D-dimer’s role in prognostication epidemiology and risk factors of thrombotic complications, and the role of prophylactic and therapeutic anticoagulation in patients with COVID-19. While existing evidence is limited in quality, COVID-19 appears to increase micro-and macro-vascular thrombosis rates in hospitalized and critically ill patients, which may contribute to the burden of disease. D-dimer can be used for risk stratification of hospitalized patients, but its role to guide anticoagulation therapy remains unclear. Evidence of higher quality is needed to address the role of therapeutic anticoagulation or high-intensity venous thromboembolism prophylaxis in COVID-19 patients. The prevalence of venous thromboembolism (VTE) in hospitalized COVID-19 patients is high, therefore, clinicians should have a high index of suspicion. The pathophysiology of thrombosis is likely related to a combination of SARS-CoV-2 direct endothelial injury and dysregulated inflammation causing coagulation activation. The current evidence on the value of D-dimer guided therapy is limited. The rate of VTE post-hospital discharge is very low, supporting the safety of current discharge practice without VTE prophylaxis in most patients. The role of higher-intensity VTE prophylaxis or therapeutic anticoagulation in critically ill COVID-19 patients without documented or suspected VTE remains uncertain. Therapeutic anticoagulation in hospitalized non-critically ill patients with COVID-19 may improve outcomes but more research is warranted.
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影响因子：
20.3
作者：
Giannis D;Allen SL;Tsang J;Flint S;Pinhasov T;Williams S;Tan G;Thakur R;Leung C;Snyder M;Bhatia C;Garrett D;Cotte C;Isaacs S;Gugerty E;Davidson A;Marder GS;Schnitzer A;Goldberg B;McGinn T;Davidson KW;Barish MA;Qiu M;Zhang M;Goldin M;Matsagkas M;Arnaoutoglou E;Spyropoulos AC
通讯作者：
Spyropoulos AC
影响因子：
158.5
作者：
Ackermann, Maximilian;Verleden, Stijn E.;Jonigk, Danny
通讯作者：
Jonigk, Danny
影响因子：
4.6
作者：
Eswaran H;Jarmul JA;Shaheen AW;Meaux D;Long T;Saccoccio D;Moll S
通讯作者：
Moll S
DOI：
10.1016/s0140-6736(20)32008-0
发表时间：
2020-10-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
Barbaro RP;MacLaren G;Boonstra PS;Iwashyna TJ;Slutsky AS;Fan E;Bartlett RH;Tonna JE;Hyslop R;Fanning JJ;Rycus PT;Hyer SJ;Anders MM;Agerstrand CL;Hryniewicz K;Diaz R;Lorusso R;Combes A;Brodie D;Extracorporeal Life Support Organization
通讯作者：
Extracorporeal Life Support Organization
影响因子：
7.3
作者：
Hamming, I;Timens, W;van Goor, H
通讯作者：
van Goor, H