Serviço de Imuno-hemoterapia. Hospital Santa Maria. Centro Hospitalar de Lisboa Norte. Lisboa. Portugal.
Serviço de Sangue e Medicina Transfusional. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
Acta Med Port. 2021 Jan 4;34(1):44-55. doi: 10.20344/amp.14784. Epub 2020 Nov 5.
COVID-19 associated coagulopathy is a dysfunction of severe SARS-CoV-2 infection, characterized by significantly increased fibrinogen, D-dimer and C reactive protein and normal to near-normal prothrombin time, activated partial thromboplastin time and platelet count. Hypercoagulopathy and hypofibrinolysis coexist and are detected by viscoelastic tests. These features, when associated with immobilization and intrinsic risk factors (age, obesity, comorbidities, drugs) of the patient, can trigger thromboembolic events, despite thromboprophylaxis. The lungs are the first and most severely damaged organ. To date, most patients have exhibited hypercoagulability on viscoelastic tests not detected by standard coagulation tests. A high rate of thrombotic events was reported, suggesting that it should be considered as a cause of clinical deterioration in intensive care and potentially other clinical settings. In advanced stage, COVID-19 associated coagulopathy, fibrinogen and platelet count can decrease significantly, depending on the severity of clinical status resembling consumptive coagulopathy. In this stage, bleeding events can occur, especially if the patient is under extracorporeal membrane oxygenation (ECMO). Viscoelastic tests are very useful tools to assess hypercoagulability and hypofibrinolysis (not detectable by standard coagulation tests) in critically ill SARS-CoV-2 patients with COVID-19 associated coagulopathy and look like very promising tools for anticoagulation management. However, further research needs to be carried out to determine whether abnormal viscoelastic tests alone or in combination with other clinical or laboratory findings can identify patients at increased thrombotic risk. Clinical trials to evaluate hypercoagulability using viscoelastic tests and the need for personalized dosage of anticoagulation in SARS-CoV-2 patientsare quickly emerging.
COVID-19 相关的凝血功能障碍是严重 SARS-CoV-2 感染的一种功能障碍，其特征是纤维蛋白原、D-二聚体和 C 反应蛋白显著增加，而凝血酶原时间、活化部分凝血活酶时间和血小板计数正常或接近正常。高凝状态和低纤维蛋白溶解并存，并通过黏弹性试验检测到。这些特征与患者的固定和内在危险因素（年龄、肥胖、合并症、药物）共同作用，可能导致血栓栓塞事件，尽管进行了血栓预防。肺部是第一个也是最严重受损的器官。迄今为止，大多数患者在黏弹性试验中表现出高凝状态，而标准凝血试验则无法检测到。据报道，血栓事件的发生率很高，这表明应将其视为重症监护和潜在其他临床环境中临床恶化的原因。在晚期，COVID-19 相关的凝血功能障碍、纤维蛋白原和血小板计数会根据临床状态的严重程度显著下降，类似于消耗性凝血障碍。在这个阶段，可能会发生出血事件，特别是如果患者正在接受体外膜氧合（ECMO）治疗。黏弹性试验是评估 COVID-19 相关凝血障碍的危重症 SARS-CoV-2 患者高凝状态和低纤维蛋白溶解（标准凝血试验无法检测到）的非常有用的工具，并且看起来是抗凝管理的很有前途的工具。然而，还需要进一步的研究来确定异常的黏弹性试验本身或与其他临床或实验室发现相结合是否可以识别出具有更高血栓形成风险的患者。评估使用黏弹性试验的高凝状态和 SARS-CoV-2 患者个体化抗凝治疗剂量的临床试验正在迅速开展。
