Pena Ana Luísa Batista, Oliveira Rafael Arantes, Severo Renata Gomes, Simões E Silva Ana Cristina
Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil.
Curr Med Chem. 2021;28(21):4207-4225. doi: 10.2174/0929867327666201005112231.
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has been a global challenge. The complicated forms of the Coronavirus Disease 2019 (COVID- 19) can evolve to multiple-organ failure, including several coagulopathies related to a sudden worsening of respiratory status. This article aimed to review studies about hematological and hemostatic laboratory disorders directly related to COVID-19 and to discuss how SARS-CoV- 2 causes these abnormalities. The coagulation cascade model is associated with both COVID- 19 and pulmonary involvement. Laboratory changes are relevant to evaluate the coagulation state - D-dimer, prothrombin time (PT), Activated Partial Thromboplastin Time (APTT), platelet count and fibrinogen. Pregnant women and patients in Extracorporeal Membrane Oxygenation (ECMO) need special attention. Prophylactic interventions for COVID-19 coagulopathy should consider patients at risk for thrombotic events and potential contraindications. The mechanisms exerted by SARS-CoV-2 that impairs hemostatic balance include endothelial injury, inflammation, and activation of the immune and complement systems. For diagnosis of coagulopathy, mainly D-dimer, but also PT, APTT and FDP, should be evaluated in COVID-19 patients. Intervention possibilities vary between low-molecular-weight heparin (LMWH) and Unfractionated Heparin (UFH). Until now, there is sufficient evidence that acutely-ill patients with risk factors for coagulopathies will benefit from thrombophylaxis during hospitalization and post-discharge, but not all patients.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染一直是一项全球性挑战。2019冠状病毒病（COVID-19）的复杂形式可演变为多器官功能衰竭，包括与呼吸状况突然恶化相关的几种凝血病。本文旨在综述与COVID-19直接相关的血液学和止血实验室异常的研究，并讨论SARS-CoV-2如何导致这些异常。凝血级联模型与COVID-19和肺部受累均有关联。实验室检查结果对于评估凝血状态很重要，包括D-二聚体、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、血小板计数和纤维蛋白原。孕妇和接受体外膜肺氧合（ECMO）治疗的患者需要特别关注。针对COVID-19凝血病的预防性干预措施应考虑血栓形成事件风险患者及潜在禁忌证。SARS-CoV-2破坏止血平衡的机制包括内皮损伤、炎症以及免疫和补体系统的激活。对于凝血病的诊断，COVID-19患者主要应评估D-二聚体，但也应评估PT、APTT和纤维蛋白降解产物（FDP）。干预方式在低分子量肝素（LMWH）和普通肝素（UFH）之间有所不同。到目前为止，有充分证据表明，有凝血病危险因素的急性病患者在住院期间和出院后进行血栓预防会受益，但并非所有患者都如此。
