Blondon Marc, Robert-Ebadi Helia
Service d'angiologie et d'hémostase, Hôpitaux universitaires de Genève, 1211 Genève 14.
Rev Med Suisse. 2021 Dec 8;17(762):2140-2144.
Severe COVID-19 is associated with venous thromboembolic events and and immuno-thrombotic phenomena, responsible for pulmonary vascular damage. This review summarizes the current knowledge on thrombotic risk in COVID-19 inpatients, the potential predictive factors (including D-dimer) and the randomized trials studying the effect of intermediate or therapeutic-dose anticoagulation on the clinical and thrombotic prognosis. Despite the initial hope, therapeutic anticoagulation does not improve the clinical prognosis in critically ill inpatients, and standard prophylactic anticoagulation is therefore recommended. In non-critical inpatients, the use of therapeutic anticoagulation may help reduce the risk of severe clinical deterioration, but its risk-benefit will be clarified in ongoing studies and meta-analyzes.
重症新型冠状病毒肺炎（COVID-19）与静脉血栓栓塞事件及免疫血栓形成现象相关，这些现象会导致肺血管损伤。本综述总结了目前关于COVID-19住院患者血栓形成风险、潜在预测因素（包括D-二聚体）以及研究中等剂量或治疗剂量抗凝对临床和血栓形成预后影响的随机试验的相关知识。尽管最初抱有希望，但治疗性抗凝并不能改善危重症住院患者的临床预后，因此推荐标准预防性抗凝。在非危重症住院患者中，使用治疗性抗凝可能有助于降低严重临床恶化的风险，但其风险效益将在正在进行的研究和荟萃分析中得以阐明。
