Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum
Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum
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DOI：
10.1007/s11239-020-02138-z
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发表时间：
2020-05-21
影响因子：
4
通讯作者：
Minichiello, Tracy
中科院分区：
文献类型：
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作者：
Barnes, Geoffrey D.;Burnett, Allison;Minichiello, Tracy
2019年冠状病毒病(新冠肺炎)是一种病毒感染，严重时可导致细胞因子风暴、全身炎症反应和凝血障碍，预示着不良预后。虽然部分但不是全部的实验室结果看起来类似于脓毒症相关的弥漫性血管内凝血病，但新冠肺炎诱导的凝血障碍似乎更多的是促血栓形成而不是出血。据推测，颈动脉闭塞可能是对新冠肺炎的一种失控的免疫血栓反应，越来越多的证据表明这些危重患者发生了静脉和动脉血栓栓塞症事件。世界各地的临床医生面临着快速确定合理的诊断、监测和抗凝策略以安全有效地管理这些患者的挑战。深思熟虑地使用经过验证的循证方法，必须与迅速出现的证据和不断增长的经验相结合，谨慎地加以平衡。本文件的目的是为抗凝论坛提供指导，该论坛是一个北美抗凝提供者组织，用于指导新冠肺炎患者的抗凝治疗。我们讨论了院内和出院后静脉血栓栓塞症的预防，疑似但未经证实的静脉血栓栓塞症的治疗，新冠肺炎的实验室监测，相关的抗凝治疗，以及针对新冠肺炎患者优化护理过渡的基本要素。
Coronavirus disease 2019 (COVID-19) is a viral infection that can, in severe cases, result in cytokine storm, systemic inflammatory response and coagulopathy that is prognostic of poor outcomes. While some, but not all, laboratory findings appear similar to sepsis-associated disseminated intravascular coagulopathy (DIC), COVID-19- induced coagulopathy (CIC) appears to be more prothrombotic than hemorrhagic. It has been postulated that CIC may be an uncontrolled immunothrombotic response to COVID-19, and there is growing evidence of venous and arterial thromboembolic events in these critically ill patients. Clinicians around the globe are challenged with rapidly identifying reasonable diagnostic, monitoring and anticoagulant strategies to safely and effectively manage these patients. Thoughtful use of proven, evidence-based approaches must be carefully balanced with integration of rapidly emerging evidence and growing experience. The goal of this document is to provide guidance from the Anticoagulation Forum, a North American organization of anticoagulation providers, regarding use of anticoagulant therapies in patients with COVID-19. We discuss in-hospital and post-discharge venous thromboembolism (VTE) prevention, treatment of suspected but unconfirmed VTE, laboratory monitoring of COVID-19, associated anticoagulant therapies, and essential elements for optimized transitions of care specific to patients with COVID-19.