Yamada Shinya, Asakura Hidesaku
Department of Hematology, Kanazawa University Hospital.
Rinsho Ketsueki. 2022;63(5):471-480. doi: 10.11406/rinketsu.63.471.
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 and is known to have thrombotic complications. Various-sized thrombosis occurs in the arteries and veins, especially in lung tissue. The prevention and treatment of thrombosis is an important issue that is directly linked to its prognosis. Additionally, the drastic fibrinolytic enhancement and lethal bleeding in some severe COVID-19 are important issues. The efficacy of antiplatelet for COVID-19 is controversial. Thus, warfarin or tranexamic acid alone should be avoided. Heparin is effective for mild to moderate COVID-19 but is ineffective in severe cases since the anticoagulant activity of heparin is insufficient or heparin increases major bleeding. In severe COVID-19 cases with drastic fibrinolytic enhancement, heparin and nafamostat combination therapy may avoid lethal bleeding. In COVID-19 clinical practice, not only the coagulation activation was evaluated but also the fibrinolytic activation to consider treatment strategies.
2019冠状病毒病（COVID-19）由严重急性呼吸综合征冠状病毒2引起，已知会出现血栓形成并发症。动脉和静脉会出现各种大小的血栓，尤其是在肺组织中。血栓形成的预防和治疗是一个直接关系到其预后的重要问题。此外，一些重症COVID-19患者出现的剧烈纤溶增强和致命性出血也是重要问题。抗血小板药物对COVID-19的疗效存在争议。因此，应避免单独使用华法林或氨甲环酸。肝素对轻度至中度COVID-19有效，但在重症病例中无效，因为肝素的抗凝活性不足或肝素会增加大出血风险。在纤溶剧烈增强的重症COVID-19病例中，肝素与那法莫司他联合治疗可能避免致命性出血。在COVID-19临床实践中，不仅要评估凝血激活情况，还要评估纤溶激活情况，以考虑治疗策略。
