From the New York Medical College, Valhalla, NY.
Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY.
Cardiol Rev. 2021 Jan/Feb;29(1):43-47. doi: 10.1097/CRD.0000000000000347.
The novel coronavirus (severe acute respiratory syndrome CoV-2 [SARS-CoV-2]), also known as COVID-19, is a single-stranded enveloped RNA virus that created a Public Health Emergency of International Concern in January 2020, with a global case burden of over 15 million in just 7 months. Infected patients develop a wide range of clinical manifestations-typically presenting with fever, cough, myalgia, and fatigue. Severely ill patients may fall victim to acute respiratory distress syndrome, acute heart injuries, neurological manifestations, or complications due to secondary infections. These critically ill patients are also found to have disrupted coagulation function, predisposing them to consumptive coagulopathies, and both venous and thromboembolic complications. Common laboratory findings include thrombocytopenia, elevated D-dimer, fibrin degradation products, and fibrinogen, all of which have been associated with greater disease severity. Many cases of pulmonary embolism have been noted, along with deep vein thrombosis, ischemic stroke, myocardial infarction, and systemic arterial embolism. The pathogenesis of coronavirus has not been completely elucidated, but the virus is known to cause excessive inflammation, endothelial injury, hypoxia, and disseminated intravascular coagulation, all of which contribute to thrombosis formation. These patients are also faced with prolonged immobilization while staying in the hospital or intensive care unit. It is important to have a high degree of suspicion for thrombotic complications as patients may rapidly deteriorate in severe cases. Evidence suggests that prophylaxis with anticoagulation may lead to a lower risk of mortality, although it does not eliminate the possibility. The risks and benefits of anticoagulation treatment should be considered in each case. Patients should be regularly evaluated for bleeding risks and thrombotic complications.
新型冠状病毒(严重急性呼吸系统综合症冠状病毒 2[SARS-CoV-2]),也称为 COVID-19,是一种单链包膜 RNA 病毒,在 2020 年 1 月引发了国际关注的公共卫生紧急事件,仅在 7 个月内,全球病例数就超过 1500 万。受感染的患者会出现多种临床表现-通常表现为发热、咳嗽、肌痛和疲劳。重症患者可能会患上急性呼吸窘迫综合征、急性心脏损伤、神经系统表现或继发感染引起的并发症。这些重症患者还被发现存在凝血功能紊乱,易患消耗性凝血病,以及静脉和血栓栓塞并发症。常见的实验室发现包括血小板减少症、D-二聚体升高、纤维蛋白降解产物和纤维蛋白原,所有这些都与疾病的严重程度有关。已经注意到许多肺栓塞病例,还有深静脉血栓形成、缺血性中风、心肌梗死和全身动脉栓塞。冠状病毒的发病机制尚未完全阐明,但已知病毒会导致过度炎症、内皮损伤、缺氧和弥散性血管内凝血,所有这些都会导致血栓形成。这些患者在住院或重症监护病房时也需要长时间的卧床休息。由于严重情况下患者可能会迅速恶化,因此对血栓并发症应保持高度警惕。有证据表明,抗凝预防可能会降低死亡率,但不能排除这种可能性。在每种情况下都应考虑抗凝治疗的风险和益处。应定期评估患者的出血风险和血栓并发症。
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