Samajdar Shambo Samrat, Sam Priya Ann, Moitra Saibal, Ray Yogiraj, Pal Jyotirmoy, Joshi Shashank R, Tripathi Santanu K
DM Resident in Clinical Pharmacology, School of Tropical Medicine, Kolkata.
Medical Advisor, Lupin Ltd., Mumbai.
J Assoc Physicians India. 2020 Sep;68(9):52-61.
Venous thromboembolism (VTE) and disseminated intravascular coagulation (DIC) are frequent cardiovascular and/or respiratory complications among hospitalized patients of COVID-19 infection. A relatively high mortality of severe coronavirus disease 2019 (COVID-19) is worrying, and the application of heparin in COVID-19 has been assessed and recommended with some expert consensus because of the risk of DIC and venous thromboembolism. However, "Risk Benefit Analysis" on the aspect of safety in using low molecular weight heparin (LMWH) in COVID-19 patients for thrombosis prophylaxis has been explained below with a few case studies and detailed information from various clinical evidence. COVID-19 infection has been associated with inflammation and a prothrombotic state, with increase in fibrin, fibrin degradation products, fibrinogen, and D-dimers. Heparin treatment including unfractionated and low molecular weight heparin appears to be associated with better prognosis in severe COVID-19 patients with coagulopathy. Major studies since the onset of this pandemic, found better prognosis in severe COVID-19 patients meeting SIC criteria or with markedly elevated D-dimer, by approaching thrombosis prophylaxis with LMWH.
静脉血栓栓塞症（VTE）和弥散性血管内凝血（DIC）是新型冠状病毒肺炎（COVID-19）感染住院患者常见的心血管和/或呼吸系统并发症。2019年重症冠状病毒病（COVID-19）相对较高的死亡率令人担忧，由于存在DIC和静脉血栓栓塞风险，肝素在COVID-19中的应用已得到评估并获得了一些专家共识的推荐。然而，下面通过一些案例研究以及来自各种临床证据的详细信息，对COVID-19患者使用低分子量肝素（LMWH）进行血栓预防的安全性方面的“风险效益分析”进行了解释。COVID-19感染与炎症和血栓前状态有关，纤维蛋白、纤维蛋白降解产物、纤维蛋白原和D-二聚体增加。包括普通肝素和低分子量肝素在内的肝素治疗似乎与重症COVID-19凝血病患者的预后改善有关。自此次大流行开始以来的主要研究发现，对于符合SIC标准或D-二聚体显著升高的重症COVID-19患者，采用LMWH进行血栓预防可获得更好的预后。
