Heparin Therapy Improving Hypoxia in COVID-19 Patients - A Case Series.
Heparin Therapy Improving Hypoxia in COVID-19 Patients - A Case Series.
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DOI：
10.3389/fphys.2020.573044
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发表时间：
2020
影响因子：
4
通讯作者：
Deheinzelin D
中科院分区：
文献类型：
--
作者：
Negri EM;Piloto BM;Morinaga LK;Jardim CVP;Lamy SAE;Ferreira MA;D'Amico EA;Deheinzelin D
升高的D-二聚体是新冠肺炎患者严重程度和死亡率的预测因子，住院期间使用肝素与死亡率降低相关。新冠肺炎患者的尸检发现微血管中有血栓，这表明高凝状态是这些患者器官衰竭的一个显著特征。有趣的是，在新冠肺炎中，尽管存在严重的低氧血症，肺顺应性仍得以保持，这证实了血流不匹配可能在呼吸衰竭的发生中起重要作用的假说。我们描述了一系列连续27例新冠肺炎患者，这些患者住进巴西S的西里奥利巴内斯医院，并根据临床严重程度量身定制地接受肝素治疗。PaO_2/FiO_2比值在抗凝开始后72小时内显著升高，从254(±90)增至325(±80)，p=0.013，92%的患者在中位时间11天内出院。无出血并发症或死亡事件发生。尽管这一非对照病例系列没有提供绝对证据证明肺循环微血栓形成是新冠肺炎呼吸衰竭的潜在机制，但患者对肝素化的阳性反应有助于了解疾病的病理生理机制，并为这些患者的治疗提供有价值的信息，同时我们正在等待进一步的前瞻性对照研究的结果。
Elevated D-dimer is a predictor of severity and mortality in COVID-19 patients, and heparin use during in-hospital stay has been associated with decreased mortality. COVID-19 patient autopsies have revealed thrombi in the microvasculature, suggesting that hypercoagulability is a prominent feature of organ failure in these patients. Interestingly, in COVID-19, pulmonary compliance is preserved despite severe hypoxemia corroborating the hypothesis that perfusion mismatch may play a significant role in the development of respiratory failure. We describe a series of 27 consecutive COVID-19 patients admitted to Sirio-Libanes Hospital in São Paulo-Brazil and treated with heparin in therapeutic doses tailored to clinical severity. PaO2/FiO2 ratio increased significantly over the 72 h following the start of anticoagulation, from 254(±90) to 325(±80), p = 0.013, and 92% of the patients were discharged home within a median time of 11 days. There were no bleeding complications or fatal events. Even though this uncontrolled case series does not offer absolute proof that micro thrombosis in the pulmonary circulation is the underlying mechanism of respiratory failure in COVID-19, patient’s positive response to heparinization contributes to the understanding of the pathophysiological mechanism of the disease and provides valuable information for the treatment of these patients while we await the results of further prospective controlled studies.
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DOI：
10.1038/nrmicro.2016.81
发表时间：
2016-08
期刊：
Nature reviews. Microbiology
影响因子：
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作者：
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作者：
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