Morishita Eriko
Department of Laboratory Science, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University.
Rinsho Ketsueki. 2021;62(8):1236-1246. doi: 10.11406/rinketsu.62.1236.
In 2020, infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) rapidly spread across the world to become a global pandemic. Coronavirus disease-2019 (COVID-19) is associated with a high rate of coagulopathy and thrombotic complications. The underlying mechanisms involved in these processes are complex. In addition to the low physical activity, blood coagulation activation accompanied by excessive immune/inflammatory reactions and vascular endothelialitis associated with the presence of intracellular SARS-CoV-2 and disrupted cell membranes contribute substantially to the complexity of the mechanisms. The types of thrombosis that occur include arterial thrombosis and venous thromboembolism. Microthrombi in alveolar capillaries are observed in COVID-19 patients. Considering the possible involvement of thrombosis in the worsening of COVID-19, prophylactic anticoagulant therapy, such as low-molecular-weight heparin or unfractionated heparin, is essential for patients with moderate and severe infections. Even with prophylactic anticoagulant therapy, the incidence of thrombosis remains high. Consequently, control of the underlying inflammation and vascular endothelial protection may be required in combination with anticoagulant therapy.
2020年，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染迅速蔓延至全球，成为一场全球大流行。2019冠状病毒病（COVID-19）与高凝血病和血栓形成并发症发生率相关。这些过程涉及的潜在机制很复杂。除了身体活动少之外，伴随着过度免疫/炎症反应的凝血激活以及与细胞内SARS-CoV-2的存在和细胞膜破坏相关的血管内皮炎，在很大程度上导致了机制的复杂性。发生的血栓类型包括动脉血栓形成和静脉血栓栓塞。在COVID-19患者中观察到肺泡毛细血管微血栓形成。考虑到血栓形成可能参与COVID-19病情恶化，对于中重度感染患者，低分子量肝素或普通肝素等预防性抗凝治疗至关重要。即使进行预防性抗凝治疗，血栓形成的发生率仍然很高。因此，可能需要在抗凝治疗的基础上控制潜在炎症并保护血管内皮。
