Zátroch István, Smudla Anikó, Babik Barna, Tánczos Krisztián, Kóbori László, Szabó Zsuzsanna, Fazakas János
Uzsoki Utcai Kórház Budapest.
Általános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika,Semmelweis Egyetem Budapest, Baross u. 23-25., 1083.
Orv Hetil. 2020 May;161(22):899-907. doi: 10.1556/650.2020.31870.
International data indicate that arterial, venous and microvascular thrombosis or disseminated intravascular coagulation occur in more than 30% of hospitalized patients with COVID-19. This condition is characterized by high levels of D-dimer and fibrinogen, prolonged prothrombin time and activated partial thromboplastin time.
Blood samples from three COVID-19 patients treated in a Hungarian intensive care unit were collected and analyzed with ClotPro® tests. EX-tests, IN-test, FIB-tests, RVV-tests, and TPA-tests were performed. The results were interpreted with respect to the clinical condition of the patients.
Procoagulation, hypercoagulation and either fibrinolysis or a "shut down" phenomenon of the fibrinolytic process were found with ClotPro®. The ClotPro® parameters were consistent with the conventional coagulation tests and corresponded with the criteria of non-overt disseminated intravascular coagulation.
These findings encourage further investigations to elucidate the underlying pathophysiology of thromboembolic events in COVID-19 patients and may support the introduction of full dose anticoagulation with or without antiplatelet therapy. Interventional clinical trials may be helpful in defining the appropriate drug(s), for this purpose, the algorithms of administration, and the optimal duration of therapy. At present, the authorization of a clinical trial that attempts to answer these questions is in progress. Orv Hetil. 2020; 161(22): 899-907.
国际数据表明，超过30%的COVID-19住院患者会发生动脉、静脉和微血管血栓形成或弥散性血管内凝血。这种情况的特征是D-二聚体和纤维蛋白原水平升高，凝血酶原时间和活化部分凝血活酶时间延长。
收集匈牙利一家重症监护病房治疗的3例COVID-19患者的血样，并用ClotPro®检测进行分析。进行了EX检测、IN检测、FIB检测、RVV检测和TPA检测。根据患者的临床状况对结果进行解释。
使用ClotPro®检测发现了促凝、高凝以及纤维蛋白溶解或纤维蛋白溶解过程的“关闭”现象。ClotPro®参数与传统凝血检测结果一致，符合非显性弥散性血管内凝血的标准。
这些发现鼓励进一步研究以阐明COVID-19患者血栓栓塞事件的潜在病理生理学，并可能支持采用全剂量抗凝治疗，无论是否联合抗血小板治疗。干预性临床试验可能有助于确定合适的药物、给药方案以及最佳治疗持续时间。目前，一项试图回答这些问题的临床试验正在获得批准。《匈牙利医学周报》。2020年；161(22):899 - 907。
