Hardy M, Lecompte T, Douxfils J, Lessire S, Dogné J M, Chatelain B, Testa S, Gouin-Thibault I, Gruel Y, Medcalf R L, Ten Cate H, Lippi G, Mullier F
Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Hematology Laboratory, Yvoir, Belgium.
Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Anesthesiology Department, Yvoir, Belgium.
Thromb J. 2020 Sep 7;18:17. doi: 10.1186/s12959-020-00230-1. eCollection 2020.
Coronavirus disease 2019 (COVID-19) is associated with extreme inflammatory response, disordered hemostasis and high thrombotic risk. A high incidence of thromboembolic events has been reported despite thromboprophylaxis, raising the question of a more effective anticoagulation. First-line hemostasis tests such as activated partial thromboplastin time, prothrombin time, fibrinogen and D-dimers are proposed for assessing thrombotic risk and monitoring hemostasis, but are vulnerable to many drawbacks affecting their reliability and clinical relevance. Specialized hemostasis-related tests (soluble fibrin complexes, tests assessing fibrinolytic capacity, viscoelastic tests, thrombin generation) may have an interest to assess the thrombotic risk associated with COVID-19. Another challenge for the hemostasis laboratory is the monitoring of heparin treatment, especially unfractionated heparin in the setting of an extreme inflammatory response. This review aimed at evaluating the role of hemostasis tests in the management of COVID-19 and discussing their main limitations.
2019冠状病毒病（COVID-19）与极端炎症反应、止血紊乱和高血栓形成风险相关。尽管进行了血栓预防，但仍有报道称血栓栓塞事件的发生率很高，这就提出了更有效抗凝治疗的问题。建议采用活化部分凝血活酶时间、凝血酶原时间、纤维蛋白原和D-二聚体等一线止血试验来评估血栓形成风险和监测止血情况，但这些试验存在许多缺点，影响其可靠性和临床相关性。专门的止血相关试验（可溶性纤维蛋白复合物、评估纤维蛋白溶解能力的试验、粘弹性试验、凝血酶生成试验）可能有助于评估与COVID-19相关的血栓形成风险。止血实验室面临的另一个挑战是监测肝素治疗，尤其是在极端炎症反应情况下的普通肝素治疗。本综述旨在评估止血试验在COVID-19管理中的作用，并讨论其主要局限性。
