Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Pkwy S, The Bronx, NY, 10461, USA.
Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Drugs. 2020 Oct;80(15):1553-1562. doi: 10.1007/s40265-020-01377-x.
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2), is now a global pandemic. This virus primarily affects the respiratory tract and causes lung injury characterized by acute respiratory distress syndrome. Although the pathophysiology of COVID-19 is not yet clear, the most widely accepted mechanism is systemic inflammation. A clinically significant effect of the inflammation is coagulopathy. As a result of this effect, patients are found to have a high risk of venous thromboembolism. Studies have reported a high incidence of thrombotic complications in critically ill patients with COVID-19. In this review, we discuss the most updated evidence on the pathophysiology, diagnosis, and treatment of the coagulopathy of COVID-19. Prophylactic anticoagulation is recommended for all in-patients with COVID-19. Those with a higher risk of developing thromboembolic events or who have already developed venous thromboembolism should be treated with therapeutic anticoagulation. We also discuss post-discharge prophylaxis for high-risk patients and some newly proposed treatments for the hypercoagulability that could improve the outcomes of the affected patients.
新型冠状病毒病（COVID-19）由严重急性呼吸系统综合征冠状病毒 2 型（SARS-CoV-2）引起，目前已在全球范围内流行。该病毒主要侵袭呼吸道，导致以急性呼吸窘迫综合征为特征的肺部损伤。虽然 COVID-19 的病理生理学尚未明确，但被广泛接受的机制是全身炎症。炎症的一个显著临床效应是凝血功能障碍。由于这一效应，患者有发生静脉血栓栓塞的高风险。研究报告 COVID-19 重症患者的血栓性并发症发生率较高。在这篇综述中，我们讨论了 COVID-19 凝血功能障碍的病理生理学、诊断和治疗方面的最新证据。建议对所有 COVID-19 住院患者进行预防性抗凝治疗。有发生血栓栓塞事件较高风险或已经发生静脉血栓栓塞的患者，应进行治疗性抗凝治疗。我们还讨论了高危患者的出院后预防措施，以及一些新提出的治疗方法，这些方法可能改善受影响患者的预后。
