Salam Shameen, Mallat Jihad, Elkambergy Hussam
Department of Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dubai, United Arab Emirates.
Respir Med Case Rep. 2020;31:101263. doi: 10.1016/j.rmcr.2020.101263. Epub 2020 Oct 15.
Cytokine storm induced by the coronavirus 19 (COVID-19) profoundly activates the coagulation cascade causing venous thromboembolism (VTE). Initial studies from Wuhan, China showed increased incidence of VTE in patients with no standard deep vein thrombosis (DVT) prophylaxis in COVID-19 pneumonia patients. Few have argued for high intensity or intermediate DVT prophylaxis in COVID-19 patients with the incidence of VTE ranging from 16 to 27% despite standard DVT prophylaxis. However, no guideline recommendations presently exist to prescribe augmented DVT prophylaxis in these patients due to lack of evidence although the risk of VTE was clearly demonstrated. While there are ongoing trials to demonstrate the efficacy of intermediate dosing against standard DVT prophylaxis in the prevention of VTE, we present a 36-year-old male admitted with COVID-19 pneumonia who developed acute high-risk pulmonary embolism (PE) requiring emergent thrombolytic therapy despite intermediate dosing DVT prophylaxis.
新型冠状病毒19（COVID-19）引发的细胞因子风暴会深度激活凝血级联反应，导致静脉血栓栓塞（VTE）。来自中国武汉的初步研究表明，COVID-19肺炎患者中，未进行标准深静脉血栓形成（DVT）预防的患者发生VTE的几率增加。尽管有标准的DVT预防措施，但仍有少数人主张对COVID-19患者进行高强度或中度DVT预防，这些患者的VTE发生率在16%至27%之间。然而，尽管VTE风险已得到明确证实，但由于缺乏证据，目前尚无指南建议对这些患者进行强化DVT预防。虽然正在进行试验以证明中度剂量预防与标准DVT预防相比在预防VTE方面的疗效，但我们报告了一名36岁男性，他因COVID-19肺炎入院，尽管进行了中度剂量DVT预防，仍发生了急性高危肺栓塞（PE），需要紧急溶栓治疗。
