COVID-19-associated coagulopathy and antithrombotic agents-lessons after 1 year.
COVID-19-associated coagulopathy and antithrombotic agents-lessons after 1 year.
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DOI：
10.1016/s2352-3026(21)00105-8
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发表时间：
2021-07
期刊：
影响因子：
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通讯作者：
Middeldorp S
中科院分区：
文献类型：
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作者：
Leentjens J;van Haaps TF;Wessels PF;Schutgens REG;Middeldorp S
COVID-19与血栓性并发症的高发生率相关，这可以通过冠状病毒与内皮细胞、局部和全身炎症反应以及凝血系统之间复杂而独特的相互作用来解释。从经验上讲，在因COVID-19住院的患者中正在使用强化剂量的血栓预防，并且已经发布了关于该主题的几项指南，尽管缺乏高质量和直接证据导致建议不足。在本观点中，我们总结了非卧床、入院、危重或非危重患者以及出院后患者的COVID-19凝血功能障碍的病理生理学。我们还回顾了过去一年中危重患者抗血栓治疗的随机对照试验数据。这些数据为COVID-19患者最佳使用抗血栓治疗提供了首个高质量证据。对于非卧床和出院后的患者，不推荐常规药物血栓预防。首次在入院的非危重患者中进行的试验表明，治疗剂量的低分子量肝素可能会改善这一人群的临床结局。在危重患者中，同样的治疗不能改善结局，建议使用预防性剂量的抗凝剂进行血栓预防。在接下来的几个月里，我们期待来自正在进行的抗血栓COVID-19研究的大量数据，以指导临床医生在疾病的不同阶段。
COVID-19 is associated with a high incidence of thrombotic complications, which can be explained by the complex and unique interplay between coronaviruses and endothelial cells, the local and systemic inflammatory response, and the coagulation system. Empirically, an intensified dose of thrombosis prophylaxis is being used in patients admitted to hospital with COVID-19 and several guidelines on this topic have been published, although the insufficiency of high quality and direct evidence has led to weak recommendations. In this Viewpoint we summarise the pathophysiology of COVID-19 coagulopathy in the context of patients who are ambulant, admitted to hospital, and critically ill or non-critically ill, and those post-discharge from hospital. We also review data from randomised controlled trials in the past year of antithrombotic therapy in patients who are critically ill. These data provide the first high-quality evidence on optimal use of antithrombotic therapy in patients with COVID-19. Pharmacological thromboprophylaxis is not routinely recommended for patients who are ambulant and post-discharge. A first ever trial in non-critically ill patients who were admitted to hospital has shown that a therapeutic dose of low-molecular-weight heparin might improve clinical outcomes in this population. In critically ill patients, this same treatment does not improve outcomes and prophylactic dose anticoagulant thromboprophylaxis is recommended. In the upcoming months we expect numerous data from the ongoing antithrombotic COVID-19 studies to guide clinicians at different stages of the disease.