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新型冠状病毒肺炎相关凝血病的见解

An Insight to ncovid-19 associated coagulopathy.

作者信息

Ashique Sumel, Khatun Tahamina

机构信息

Department of Pharmaceutics, Bharat Institute of Technology, Meerut-250103, Uttar Pradesh. India.

Department of Life Science, Katiahat B.K.A.P Institution, West Bengal-743427. India.

出版信息

Curr Drug Res Rev. 2021 Nov 18. doi: 10.2174/2589977513666211119110148.

Abstract

Several current studies have highlighted the high occurrence of coagulopathy in nCOVID-19 infection. The corona virus often prompts hypercoagulability along with both microangiopathy and local thrombus development, and systemic coagulation limitation which causes large vessel thrombosis and key thromboembolic issues such as pulmonary embolism in seriously ill hospitalized patients. Based on recent reports, the most severely ill patients present with coagulopathy, and disseminated intravascular coagulation (DIC)-like massive intravascular clot formation is frequently seen in this cohort. Therefore, coagulation tests may be considered useful to discriminate severe cases of nCOVID-19. The clinical presentation of nCOVID-19-associated coagulopathy is organ dysfunction primarily, while hemorrhagic events are less frequent. Changes in hemostatic biomarkers represented by increase in D-dimer and fibrin/fibrinogen degradation products indicate the essence of coagulopathy is massive fibrin formation. Overall, the patients have an increase in venous and arterial thrombotic events especially in ICU patients. Routine thromboprophylaxis with low molecular weight heparin is recommended in all hospitalized patients to reduce the incidence of thrombosis. Though, the importance of thromboembolic impediments has not been extensively spotlighted, thus the rationale of this article is to provide recent information about this severe difficulty. In this article the mechanism of coagulopathy, associated problems and possible therapeutics has been reviewed.

摘要

目前的几项研究强调了新型冠状病毒肺炎(nCOVID-19)感染中凝血病的高发生率。冠状病毒常引发高凝状态,同时伴有微血管病和局部血栓形成,以及全身凝血功能受限,这会导致重症住院患者出现大血管血栓形成和关键的血栓栓塞问题,如肺栓塞。根据最近的报告,病情最严重的患者会出现凝血病,并且在这一群体中经常可见弥散性血管内凝血(DIC)样的大量血管内血栓形成。因此,凝血检查可能有助于鉴别nCOVID-19的重症病例。nCOVID-19相关凝血病的临床表现主要是器官功能障碍,而出血事件较少见。以D-二聚体和纤维蛋白/纤维蛋白原降解产物增加为代表的止血生物标志物变化表明,凝血病的本质是大量纤维蛋白形成。总体而言,患者尤其是重症监护病房(ICU)患者的静脉和动脉血栓形成事件增加。建议对所有住院患者进行低分子量肝素常规血栓预防,以降低血栓形成的发生率。然而,血栓栓塞障碍的重要性尚未得到广泛关注,因此本文的目的是提供有关这一严重问题的最新信息。本文对凝血病的机制、相关问题及可能的治疗方法进行了综述。

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