Department of Medicine, University of California Los Angeles, Hematology/Oncology, Los Angeles, California.
Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California.
Semin Respir Crit Care Med. 2021 Apr;42(2):316-326. doi: 10.1055/s-0041-1722992. Epub 2021 Feb 6.
Venous thromboembolism, occlusion of dialysis catheters, circuit thrombosis in extracorporeal membrane oxygenation (ECMO) devices, acute limb ischemia, and isolated strokes, all in the face of prophylactic and even therapeutic anticoagulation, are features of novel coronavirus disease 2019 (COVID-19) coagulopathy. It seems well established at this time that a COVID-19 patient deemed sick enough to be hospitalized, should receive at least prophylactic dose anticoagulation. However, should some hospitalized patients have dosage escalation to intermediate dose? Should some be considered for full-dose anticoagulation without a measurable thromboembolic event and how should that anticoagulation be monitored? Should patients receive postdischarge anticoagulation and with what medication and for how long? What thrombotic issues are related to the various medications being used to treat this coagulopathy? Is antiphospholipid antibody part of this syndrome? What is the significance of isolated ischemic stroke and limb ischemia in this disorder and how does this interface with the rest of the clinical and laboratory features of this disorder? The aims of this article are to explore these questions and interpret the available data based on the current evidence.
静脉血栓栓塞、透析导管阻塞、体外膜肺氧合（ECMO）设备中的回路血栓形成、急性肢体缺血和孤立性中风，所有这些都发生在新型冠状病毒疾病 2019（COVID-19）凝血功能障碍的预防性甚至治疗性抗凝治疗中。目前看来，对于那些病情严重到需要住院治疗的 COVID-19 患者，至少应接受预防性剂量抗凝治疗。然而，一些住院患者是否应该增加剂量至中等剂量？是否应该考虑对没有可测量的血栓栓塞事件的患者进行全剂量抗凝治疗，以及应该如何监测抗凝治疗？患者是否需要接受出院后抗凝治疗，使用何种药物以及治疗多长时间？治疗这种凝血功能障碍的各种药物与哪些血栓形成问题有关？抗磷脂抗体是否是该综合征的一部分？在这种疾病中，孤立性缺血性中风和肢体缺血的意义是什么，以及它与该疾病的其他临床和实验室特征如何相互作用？本文的目的是探讨这些问题，并根据现有证据解释可用数据。
