Haemostasis and Thrombosis Center, Cremona Hospital, Viale Concordia 1, 26100, Cremona, Italy.
Division of Internal Medicine, Cremona Hospital, Viale Concordia 1, 26100 Cremona, Italy.
Intern Emerg Med. 2020 Aug;15(5):751-753. doi: 10.1007/s11739-020-02331-1. Epub 2020 Apr 15.
The development of COVID-19 syndrome in anticoagulated patients, and especially their admission to intensive-care units with acute severe respiratory syndrome (SARS-CoV-2), expose them to specific problems related to their therapy, in addition to those associated with the acute viral infection. Patients on VKA hospitalized with SARS-CoV-2 show high instability of PT INR due to the variability of vitamin K metabolism, diet, fasting, co-medications, liver impairment, and heart failure. Patients on DOAC are exposed to under/over treatment caused by significant pharmacological interferences. In consideration of the pharmacological characteristics of oral anticoagulant drugs, the multiple pharmacological interactions due to the treatment of acute disease and the possible necessity of mechanical ventilation with hospitalization in intensive-care units, we suggest replacing oral anticoagulant therapies (VKA and DOAC) with parenteral heparin to avoid the risk of over/under treatment.
COVID-19 综合征在抗凝患者中的发展，尤其是他们因急性严重呼吸综合征（SARS-CoV-2）入住重症监护病房，使他们除了与急性病毒感染相关的问题外，还面临与治疗相关的特殊问题。因维生素 K 代谢、饮食、禁食、合并用药、肝损伤和心力衰竭等因素的变化，接受 SARS-CoV-2 治疗的 VKA 住院患者的 PT-INR 不稳定程度较高。接受 DOAC 治疗的患者因存在显著的药物相互作用而面临治疗不足/过度的风险。鉴于口服抗凝药物的药理学特点，急性疾病治疗的多种药物相互作用以及可能需要在重症监护病房进行机械通气和住院治疗，我们建议用普通肝素替代口服抗凝治疗（VKA 和 DOAC），以避免治疗不足/过度的风险。
