COVID-19 and its implications for thrombosis and anticoagulation
COVID-19 and its implications for thrombosis and anticoagulation
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DOI：
10.1182/blood.2020006000
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发表时间：
2020-06-04
期刊：
影响因子：
20.3
通讯作者：
Levy, Jerrold H.
中科院分区：
文献类型：
--
作者：
Connors, Jean M.;Levy, Jerrold H.
严重急性呼吸综合征冠状病毒 2、2019 冠状病毒病 (COVID-19) 引起的感染可能与凝血病相关，这一发现与在弥散性血管内凝血病 (DIC) 患者中观察到的感染引起的炎症变化一致。由于事先缺乏对 COVID-19 的免疫力，导致全球范围内出现大量感染患者，并且这种病毒性疾病过程中出现的并发症的治疗也存在不确定性。肺部是 COVID-19 的靶器官；患者出现急性肺损伤，可进展为呼吸衰竭，但也可能发生多器官衰竭。 COVID-19 的初始凝血病表现为 D-二聚体和纤维蛋白/纤维蛋白原降解产物显着升高，而凝血酶原时间、部分凝血活酶时间和血小板计数的异常在初始表现中相对罕见。建议进行凝血测试筛查，包括测量 D-二聚体和纤维蛋白原水平。应按照对危重住院患者使用血栓栓塞预防的既定做法，以及对脓毒症引起的凝血病或 DIC 患者采取标准支持性护理措施，对与任何危重患者相同的新冠肺炎相关凝血病进行管理。尽管 D-二聚体、脓毒症生理学和消耗性凝血病是死亡率的指标，但目前的数据并不建议使用全强度抗凝剂量，除非另有临床指示。尽管 COVID-19 与凝血障碍相关，但出血表现（即使是 DIC 患者）也尚未报道。如果确实发生出血，应遵循 DIC 和出血处理的标准指南。
Severe acute respiratory syndrome coronavirus 2, coronavirus disease 2019 (COVID-19)-induced infection can be associated with a coagulopathy, findings consistent with infection-induced inflammatory changes as observed in patients with disseminated intravascular coagulopathy (DIC). The lack of prior immunity to COVID-19 has resulted in large numbers of infected patients across the globe and uncertainty regarding management of the complications that arise in the course of this viral illness. The lungs are the target organ for COVID-19; patients develop acute lung injury that can progress to respiratory failure, although multiorgan failure can also occur. The initial coagulopathy of COVID-19 presents with prominent elevation of D-dimer and fibrin/fibrinogen-degradation products, whereas abnormalities in prothrombin time, partial thromboplastin time, and platelet counts are relatively uncommon in initial presentations. Coagulation test screening, including the measurement of D-dimer and fibrinogen levels, is suggested. COVID19-associated coagulopathy should be managed as it would be for any critically ill patient, following the established practice of using thromboembolic prophylaxis for critically ill hospitalized patients, and standard supportive care measures for those with sepsis-induced coagulopathy or DIC. Although D-dimer, sepsis physiology, and consumptive coagulopathy are indicators of mortality, current data do not suggest the use of full-intensity anticoagulation doses unless otherwise clinically indicated. Even though there is an associated coagulopathy with COVID-19, bleeding manifestations, even in those with DIC, have not been reported. If bleeding does occur, standard guidelines for the management of DIC and bleeding should be followed.