Debakey Cardiovascular Center, Houston Methodist Hospital-Texas Medical Center, Houston, TX, USA.
Department of Medicine, Mount Sinai Morningside-West, the Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Hosp Pract (1995). 2021 Dec;49(5):307-324. doi: 10.1080/21548331.2021.2007648. Epub 2021 Dec 6.
Severe acute respiratory syndrome coronavirus 2 infections are associated with greater risk of both arterial and venous thromboembolic events. This has been attributed to a florid proinflammatory state resulting in microvascular dysfunction, activation of platelets and procoagulant systems as well as possible direct endothelial injury. The associated morbidity and mortality of these events has prompted much speculation and varied anticoagulation and fibrinolytic strategies based on multiple criteria including disease severity and biomarkers. No clear definitive benefit has been established with these approaches, which have frequently led to greater bleeding complications without significant mortality benefit. In this review, we outline the burden of these thromboembolic events in coronavirus disease-2019 (COVID-19) as well as the hypothesized contributory biological mechanisms. Finally, we provide a brief overview of the major clinical studies on the topic, and end with a summary of major societal guideline recommendations on anticoagulation in COVID-19.
严重急性呼吸综合征冠状病毒 2 感染与动脉和静脉血栓栓塞事件的风险增加有关。这归因于一种明显的促炎状态，导致微血管功能障碍、血小板和促凝系统激活以及可能的直接内皮损伤。这些事件的相关发病率和死亡率引起了很多猜测，并根据多种标准（包括疾病严重程度和生物标志物）制定了不同的抗凝和溶栓策略。这些方法并没有明确的明确益处，它们经常导致更多的出血并发症，而没有显著的生存获益。在这篇综述中，我们概述了这些血栓栓塞事件在 2019 冠状病毒病（COVID-19）中的负担，以及假设的促成生物学机制。最后，我们简要概述了关于该主题的主要临床研究，并以 COVID-19 抗凝治疗的主要社会指南建议的总结结束。
