Bertoletti Laurent, Bikdeli Behnood, Zuily Stéphane, Blondon Marc, Mismetti Patrick
Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France; INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, F-42055 Saint-Etienne, France; INSERM, CIC-1408, CHU Saint-Etienne, F-42055 Saint-Etienne, France; F-CRIN INNOVTE network, Saint-Etienne, France.
Brigham and Women's Hospital, Cardiovascular Medicine Division, Boston, United States; Yale University School of Medicine, Center for Outcomes Research and Evaluation (CORE), New Haven, United States; Cardiovascular Research Foundation, New York, United States.
Vascul Pharmacol. 2021 Aug;139:106883. doi: 10.1016/j.vph.2021.106883. Epub 2021 Jun 4.
The outbreak of 2019 novel coronavirus disease (Covid-19) has deeply challenged the world population, but also our medical knowledge. Special attention has been paid early to an activation of coagulation, then to an elevated rate of venous thromboembolism (VTE) in patients hospitalized with severe COVID-19. These data suggested that anticoagulant drugs should be evaluated in the treatment of patients with COVID-19. The publication of unexpected high rates of VTE in patients hospitalized with COVID-19, despite receiving thromboprophylaxis, open the way to dedicated trials, evaluating modified regimens of thromboprophylaxis. Moreover, the further improvement in our comprehension of the disease, particularly the pulmonary endothelial dysfunction increased the hope that anticoagulant drugs may also protect patients from pulmonary thrombosis. In this comprehensive review, we cover the different situations where thromboprophylaxis standard may be modified (medically-ill inpatients, ICU inpatients, outpatients), and describe some of the current randomized controls trials evaluating new regimens of thromboprophylaxis in patients with COVID-19, including the preliminary available results. We also discuss the potential of anticoagulant drugs to target the thromboinflammation described in patients with severe COVID-19.
2019新型冠状病毒病（Covid-19）的爆发给全球人口带来了严峻挑战，也对我们的医学知识提出了考验。早期人们就特别关注到新冠病毒感染者凝血功能的激活，以及重症Covid-19住院患者静脉血栓栓塞（VTE）发生率的升高。这些数据表明，抗凝药物应在Covid-19患者的治疗中进行评估。尽管接受了血栓预防治疗，但Covid-19住院患者仍出现意外高的VTE发生率，这为专门评估改良血栓预防方案的试验开辟了道路。此外，我们对该疾病理解的进一步深入，特别是肺部内皮功能障碍的发现，增加了人们对抗凝药物可能预防肺部血栓形成的期望。在这篇综述中，我们涵盖了可能需要修改血栓预防标准的不同情况（内科住院患者、重症监护病房住院患者、门诊患者），并描述了目前一些评估Covid-19患者新血栓预防方案的随机对照试验，包括初步的可用结果。我们还讨论了抗凝药物针对重症Covid-19患者血栓炎症的潜力。
