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COVID-19 引起的同时发生的显性弥漫性血管内凝血和急性双侧肺栓塞的独特病例报告。

A unique tale of COVID-19 induced concomitant overt disseminated intravascular coagulation and acute bilateral pulmonary embolism.

机构信息

William Harvey Hospital, UK.

William Harvey Hospital, UK.

出版信息

Int J Infect Dis. 2021 Mar;104:568-571. doi: 10.1016/j.ijid.2021.01.040. Epub 2021 Jan 21.

DOI:10.1016/j.ijid.2021.01.040
PMID:33486013
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7825839/
Abstract

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2), a novel coronavirus, originated as an epidemic respiratory illness in Wuhan, China. COVID-19 eventually spread to almost all countries and has now been declared a global pandemic disease by the World Health Organisation. A plethora of research has explored the dynamics of different clinical entities related to SARS-COV-2, in particular, COVID-19 associated coagulopathy. A large scale of patients have been reported to have developed pulmonary embolism without any other standard triggers or risk factors, leading to speculation that COVID-19 is an independent risk factor for venous thromboembolism. In addition to the development of thromboembolic complications such as pulmonary embolism, COVID-19 has also been reported to have triggered disseminated intravascular coagulation (DIC); however, it is unclear whether pulmonary embolism was due to COVID-19-induced thrombosis or a result of coagulopathy secondary to DIC. We describe a unique case of a COVID-19 associated coagulopathy in a patient with confirmed pulmonary embolism along with an overt DIC. Following diagnosis, the challenge was to identify the appropriate treatment modality for this unique situation. The patient was treated with anticoagulants and steroids along with blood products. The patient's condition markedly improved and was clinically stable on discharge.

摘要

严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)是一种新型冠状病毒,最初在中国武汉爆发为一种流行的呼吸道疾病。COVID-19 最终传播到几乎所有国家,并已被世界卫生组织宣布为全球大流行疾病。大量研究探讨了与 SARS-CoV-2 相关的不同临床实体的动态,特别是与 COVID-19 相关的凝血障碍。大量报告显示,许多患者在没有任何其他标准诱因或危险因素的情况下发生了肺栓塞,这导致人们推测 COVID-19 是静脉血栓栓塞的独立危险因素。除了发生血栓栓塞并发症(如肺栓塞)外,COVID-19 还被报道引发弥漫性血管内凝血(DIC);然而,尚不清楚肺栓塞是由于 COVID-19 引起的血栓形成还是由于 DIC 引起的凝血障碍所致。我们描述了一例 COVID-19 相关凝血障碍合并明确肺栓塞的独特病例。在明确诊断后,挑战在于确定这种特殊情况下的适当治疗方式。该患者接受了抗凝药物和类固醇以及血液制品治疗。患者的病情显著改善,出院时临床情况稳定。

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本文引用的文献

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Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review.2019冠状病毒病(COVID-19)肺炎患者的肺栓塞:一项叙述性综述
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Massive pulmonary embolism following recovery from COVID-19 infection: inflammation, thrombosis and the role of extended thromboprophylaxis.新冠病毒感染康复后发生的大面积肺栓塞:炎症、血栓形成及延长血栓预防的作用
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Microthrombotic Complications of COVID-19 Are Likely Due to Embolism of Circulating Endothelial Derived Ultralarge Von Willebrand Factor (eULVWF) Decorated-Platelet Strings.
COVID-19的微血栓并发症可能是由于循环中内皮衍生的超大血管性血友病因子(eULVWF)修饰的血小板串的栓塞所致。
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Systemic endothelial dysfunction: A common pathway for COVID-19, cardiovascular and metabolic diseases.全身内皮功能障碍:新冠病毒病、心血管疾病和代谢性疾病的共同途径。
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Intensive Care Med. 2020 Jun;46(6):1105-1108. doi: 10.1007/s00134-020-06059-6. Epub 2020 Apr 28.
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COVID-19 and its implications for thrombosis and anticoagulation.新型冠状病毒肺炎及其对血栓形成和抗凝的影响。
Blood. 2020 Jun 4;135(23):2033-2040. doi: 10.1182/blood.2020006000.
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Pulmonary Embolism in Patients With COVID-19: Awareness of an Increased Prevalence.2019冠状病毒病患者的肺栓塞:对患病率增加的认识
Circulation. 2020 Jul 14;142(2):184-186. doi: 10.1161/CIRCULATIONAHA.120.047430. Epub 2020 Apr 24.
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J Clin Virol. 2020 Jun;127:104362. doi: 10.1016/j.jcv.2020.104362. Epub 2020 Apr 9.
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