Thrombotic Complications in Patients with COVID-19: Pathophysiological Mechanisms, Diagnosis, and Treatment.
Thrombotic Complications in Patients with COVID-19: Pathophysiological Mechanisms, Diagnosis, and Treatment.
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DOI：
10.1007/s10557-020-07084-9
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发表时间：
2021-04
影响因子：
3.4
通讯作者：
Chiva-Blanch G
中科院分区：
文献类型：
--
作者：
Gąsecka A;Borovac JA;Guerreiro RA;Giustozzi M;Parker W;Caldeira D;Chiva-Blanch G
新的证据表明，COVID-19 的严重临床表现与血栓栓塞风险增加之间存在关联。三分之一因重症 COVID-19 住院的患者会出现大血管血栓并发症，包括静脉血栓栓塞、心肌损伤/梗塞和中风。同时，尸检系列表明多器官损伤模式与微血管损伤一致。 COVID-19 相关凝血病具有明显的特征，包括 D-二聚体浓度显着升高，而活化部分凝血活酶时间、凝血酶原时间和血小板计数几乎正常。由于肺栓塞和严重的 COVID-19 疾病之间存在重叠特征，例如呼吸困难、高浓度 D-二聚体、右心室功能障碍或扩大以及急性呼吸窘迫综合征，诊断可能具有挑战性。大血管和微血管并发症均与院内死亡风险增加相关。因此，早期识别住院COVID-19患者的凝血异常是识别预后不良患者、指导抗血栓预防或治疗、改善患者临床结局的关键措施。大多数代表专注于血栓和止血的专业协会发布的指南和共识文件主张对所有因 COVID-19 住院的患者以及出院后 2-6 周（在没有禁忌症的情况下）使用抗凝剂。然而，由于没有关于决定抗凝强度和持续时间的指南，因此应根据具体情况做出决策。在此，我们回顾炎症与血栓形成之间的机制关系，讨论大血管和微血管并发症，并总结 COVID-19 患者血栓栓塞的预防、诊断和治疗。
Emerging evidence points to an association between severe clinical presentation of COVID-19 and increased risk of thromboembolism. One-third of patients hospitalized due to severe COVID-19 develops macrovascular thrombotic complications, including venous thromboembolism, myocardial injury/infarction and stroke. Concurrently, the autopsy series indicate multiorgan damage pattern consistent with microvascular injury. COVID-19 associated coagulopathy has distinct features, including markedly elevated D-dimers concentration with nearly normal activated partial thromboplastin time, prothrombin time and platelet count. The diagnosis may be challenging due to overlapping features between pulmonary embolism and severe COVID-19 disease, such as dyspnoea, high concentration of D-dimers, right ventricle with dysfunction or enlargement, and acute respiratory distress syndrome. Both macro- and microvascular complications are associated with an increased risk of in-hospital mortality. Therefore, early recognition of coagulation abnormalities among hospitalized COVID-19 patients are critical measures to identify patients with poor prognosis, guide antithrombotic prophylaxis or treatment, and improve patients’ clinical outcomes. Most of the guidelines and consensus documents published on behalf of professional societies focused on thrombosis and hemostasis advocate the use of anticoagulants in all patients hospitalized with COVID-19, as well as 2-6 weeks post hospital discharge in the absence of contraindications. However, since there is no guidance for deciding the intensity and duration of anticoagulation, the decision-making process should be made in individual-case basis. Here, we review the mechanistic relationships between inflammation and thrombosis, discuss the macrovascular and microvascular complications and summarize the prophylaxis, diagnosis and treatment of thromboembolism in patients affected by COVID-19.
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DOI：
10.1111/jth.14849
发表时间：
2020-07
期刊：
Journal of thrombosis and haemostasis : JTH
影响因子：
--
作者：
通讯作者：
--
影响因子：
15.9
作者：
Chen, Guang;Wu, Di;Ning, Qin
通讯作者：
Ning, Qin
影响因子：
4.6
作者：
Enz Hubert, Rodolfo Monteiro;Rodrigues, Melina Veiga;De Paula, Erich Vinicius
通讯作者：
De Paula, Erich Vinicius
影响因子：
10.4
作者：
Cui, Songping;Chen, Shuo;Wang, Feng
通讯作者：
Wang, Feng
影响因子：
10.4
作者：
Chen, D.;Dorling, A.
通讯作者：
Dorling, A.