López-Reyes Raquel, Oscullo Grace, Jiménez David, Cano Irene, García-Ortega Alberto
Servicio de Neumología, Hospital Universitario y Politécnico la Fe, Valencia, España.
Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España.
Arch Bronconeumol. 2021 Jan;57:55-64. doi: 10.1016/j.arbres.2020.07.033. Epub 2020 Aug 31.
The new SARS-CoV-2 coronavirus has created an unprecedented global health problem, resulting in more than 250,000 confirmed deaths. The disease produced by this virus, called Covid-19, presents with variable clinical manifestations, from practically asymptomatic patients with catarrhal processes to severe pneumonias that rapidly evolve to acute respiratory distress syndrome (ARDS) and multiorgan failure. In recent weeks, papers have been published describing coagulation disorders and arterial and venous thrombotic complications in these patients, mainly among those admitted to intensive care units. The infection triggers an immune response, which causes different inflammatory mediators to be released into the blood. These include cytokines, which interact with platelets and different coagulation proteins, and promote thrombogenesis. One of the most widely studied coagulation markers in Covid-19 is D-dimer (DD), raised levels of which have prognostic implications, although the best cut-off point for the diagnosis of venous thromboembolism (VTE) in this population has not been clarified, nor has its usefulness in determining the intensity of thromboprophylaxis required in these patients. Until sufficiently robust information (preferably from well-designed clinical trials) is available, the recommendations of clinical practice guidelines for the prophylaxis, diagnosis and treatment of VTE should be followed in Covid-19 patients.
新型严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引发了一场前所未有的全球健康危机,导致超过25万人确诊死亡。这种病毒引发的疾病称为新冠肺炎(Covid-19),临床表现多样,从伴有卡他症状的几乎无症状患者到迅速发展为急性呼吸窘迫综合征(ARDS)和多器官功能衰竭的严重肺炎患者都有。最近几周,已有论文发表,描述了这些患者,主要是入住重症监护病房的患者的凝血功能障碍以及动脉和静脉血栓形成并发症。感染引发免疫反应,导致不同的炎症介质释放到血液中。这些介质包括细胞因子,它们与血小板和不同的凝血蛋白相互作用,促进血栓形成。新冠肺炎中研究最广泛的凝血标志物之一是D-二聚体(DD),其水平升高具有预后意义,尽管尚未明确该人群中静脉血栓栓塞症(VTE)诊断的最佳临界值,其在确定这些患者所需的血栓预防强度方面的效用也不明确。在获得足够有力的信息(最好来自精心设计的临床试验)之前,新冠肺炎患者应遵循VTE预防、诊断和治疗的临床实践指南建议。