Department of Radiology, Catharina Hospital Eindhoven, the Netherlands.
Department of Anesthesiology and Intensive Care, Catharina Hospital Eindhoven, the Netherlands.
J Crit Care. 2020 Dec;60:106-110. doi: 10.1016/j.jcrc.2020.08.002. Epub 2020 Aug 8.
The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has emerged early December 2019 and was recently confirmed by the World Health Organization (WHO) to be a public health emergency of international concern. Earlier reports have shown coagulopathy in patients with severe coronavirus disease 2019 (Covid-19).
We present four critically ill Covid-19 patients, who were admitted to our hospital. They were treated with supportive care, oral chloroquine, and standard 2500 or 5000 International Units (IU) of dalteparine subcutaneously once daily. Two patients died during the course of their stay as a consequence of severe large vessel arterial thromboembolism. The other two patients survived but symptoms of paralysis and aphasia persisted after cerebral ischemia due to large vessel arterial thromboembolism. Patients showed no signs of overt disseminated intravascular coagulation (DIC) in their laboratory analysis.
This case series suggest that even in absence of overt DIC, arterial thromboembolic complications occur in critically ill patients with Covid-19. Further studies are needed to determine which parameters are useful in monitoring coagulopathy and which dose of anti-thrombotic therapy in Covid-19 patients is adequate, even when overt DIC is not present.
新型严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）于 2019 年 12 月初出现，世界卫生组织（WHO）最近确认其为国际关注的公共卫生紧急事件。早期报告显示，严重冠状病毒病 2019（Covid-19）患者存在凝血功能障碍。
我们介绍了 4 名重症 Covid-19 患者，他们被收入我院治疗。他们接受了支持性治疗、口服氯喹以及每天皮下给予标准的 2500 或 5000 国际单位（IU）达肝素钠治疗。由于大血管动脉血栓栓塞，2 名患者在住院期间死亡。另外 2 名患者存活，但由于大血管动脉血栓栓塞导致脑缺血后仍存在瘫痪和失语症状。患者的实验室分析中没有明显弥散性血管内凝血（DIC）的迹象。
本病例系列表明，即使没有明显的 DIC，重症 Covid-19 患者也会发生动脉血栓栓塞并发症。需要进一步研究以确定哪些参数可用于监测凝血功能障碍，以及在即使没有明显 DIC 的情况下，Covid-19 患者的抗血栓治疗剂量是否足够。
