Preview

Вестник анестезиологии и реаниматологии

Расширенный поиск

Тромбоэмболические осложнения при заболевании COVID-19, коротко об изменениях в рекомендациях

https://doi.org/10.21292/2078-5658-2021-18-1-37-46

Полный текст:

Аннотация

Роль коагулопатии при тяжелой новой коронавирусной инфекции еще предстоит выяснить. Механизмы коагулопатии можно суммировать по двум основным направлениям: пути, обусловленные воспалением, и пути, связанные со специфическими вирусами. Частота тромбоэмболических событий высока, при этом тромбоэмболия легочной артерии является наиболее частым тромбоэмболическим осложнением. Низкомолекулярный гепарин считается основным профилактическим и терапевтическим средством у пациентов с COVID-19. Лечение тромбоэмболических осложнений следует начинать без промедления во всех случаях с определенным или клинически подозреваемым диагнозом, подтвержденным или нет определенными диагностическими методами. В обзоре рассмотрены: механизмы развития коагулопатии при COVID-19, в том числе связанные непосредственно с действием вируса; диагностическая значимость биохимических маркеров и тромбоэластографии; частота встречающихся тромбоэмболических событий; подходы к профилактике и лечению связанной с COVID-19 коагулопатией.

Об авторах

А. Лаврентьева
Больница Папаниколау
Греция

Лаврентьева Афина врач, доктор философии, заведующая отделением интенсивной терапии 

Эксохи, Пилая-Хортиатис, Салоники, Греция, 57010

Тел.: +302313307932



С. Тсотсолис
Университет Аристотеля
Греция
Тсотсолис Ставрос Врач, магистр философии


Список литературы

1. Antoniak S., Mackman N. Multiple roles of the coagulation protease cascade during virus infection // Blood. ‒ 2014. ‒ Vol. 24, № 123. ‒ P. 2605–2613. doi: 10.1182/blood-2013-09-526277.

2. Bayer G., von Tokarski F., Thoreau B. et al. Etiology and outcomes of thrombotic microangiopathies // Clin. J. Am. Soc. Nephrol. ‒ 2019. ‒ Vol. 14, № 4. ‒ P. 557–566. doi: 10.2215/CJN. 11470918.

3. Begbie M., Notley C., Tinlin S. et al. The Factor VIII acute phase response requires the participation of NFkappaB and C/EBP // Thromb. Haemost. ‒ 2000. ‒ Vol. 84, № 2. ‒ P. 216–222. PMID: 10959692.

4. Beun R., Kusadasi N., Sikma M. et al. Thromboembolic events and apparent heparin resistance in patients infected with SARS-CoV-2 // Int. J. Lab. Hematol. ‒ 2020. ‒ Vol. 42, Suppl. 1. ‒ P. 19–20. https://doi.org/10.1111/ijlh.13230.

5. Boonyawat K., Chantrathammachart P., Numthavaj P. et al. Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis // Thromb. J. ‒ 2020. ‒ Vol. 18, № 1. ‒ P. 34. doi: 10.1186 / s12959-020-00248-5.

6. Campbell C. M., Kahwash R. Will complement inhibition be the new target in treating COVID-19-related systemic thrombosis? // Circulation. ‒ 2020. ‒ Vol. 141, № 22. ‒ Р. 1739–1741. doi: 10.1161/CIRCULATIONAHA.120.047419.

7. Cohen T., Nahari D., Cerem L. W. et al. Interleukin 6 induces the expression of vascular endothelial growth factor // J. Biol. Chem. ‒ 1996. ‒ Vol. 12, № 271 (2). ‒ P. 736–741. doi: 10.1074/jbc.271.2.736.

8. Demelo-Rodríguez P., Cervilla-Muñoz E., Ordieres-Ortega L. et al. Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels // Thromb. Res. ‒ 2020. ‒ Vol. 192. ‒ P. 23–26. doi: 10.1016/j. thromres. 2020. 05. 018.

9. Erickson Y. O., Samia N. I., Bedell B. et al. Elevated procalcitonin and c-reactive protein as potential biomarkers of sepsis in a subpopulation of thrombotic microangiopathy patients // J. Clin. Apheresis. ‒ 2009. ‒ Vol. 24, № 4. ‒ P. 150–154. doi: 10.1002/jca. 20205.

10. Fogarty H., Townsend L., Ni Cheallaigh C. et al. COVID19 coagulopathy in Caucasian patients // Br. J. Haematol. ‒ 2020. ‒ Vol. 189, № 6. ‒ P. 1044–1049. doi: 10.1111/bjh. 16749.

11. Helms J., Tacquard C., Severac F. et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study // Intens. Care Med. ‒ 2020. ‒Vol. 46, № 6. ‒ P. 1089–1098. doi: 10.1007/s00134-020-06062-X.

12. Huang D., Wong E., Zuo M.-L. et al. Risk of venous thromboembolism in Chinese pregnant women: Hong Kong venous thromboembolism study // Blood Res. ‒ 2019. ‒ Vol. 54, № 3. ‒ P. 175–180. doi: 10.5045/br.2019.54.3.175.

13. Huebner B. R., Moore E. E., Moore H. B. et al. Thrombin provokes degranulation of platelet α-granules leading to the release of active plasminogen activator inhibitor-1 (PAI-1) // Shock Augusta Ga. ‒ 2018. ‒ Vol. 50, № 6. ‒ P. 671–676. doi: 10.1097/SHK.0000000000001089.

14. Iba T., Levy J. H., Levi M. et al. Coagulopathy of Coronavirus Disease 2019 // Crit. Care Med. ‒ 2020. ‒ Vol. 48, № 9. ‒ P. 1358–1364. doi: 10.1097 / CCM. 0000000000004458.

15. Joly B. S., Siguret V., Veyradier A. Understanding pathophysiology of hemostasis disorders in critically ill patients with COVID-19 // Intens. Care Med. ‒ 2020. ‒ Vol. 46, № 8. ‒ P. 1603–1606. doi: 10.1007/s00134-020-06088-1.

16. Klok F. A., Kruip M. J. H. A., van der Meer N. J. M. et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19 // Thromb. Res. ‒ 2020. ‒ Vol. 191. ‒ P. 145–147. doi: 10.1016 / j. thromres. 2020. 04. 013.

17. Lazzaroni M. G., Piantoni S., Masneri S. et al. Coagulation dysfunction in COVID-19: The interplay between inflammation, viral infection and the coagulation system // Blood Rev. ‒ 2020. ‒ Vol. 24. ‒ P. 100745. doi: 10.1101/2020.02.27.20027557.

18. Levi M., Scully M. How I treat disseminated intravascular coagulation // Blood. ‒ 2018. ‒ Vol. 131, № 8. ‒ P. 845–854. https://doi.org/10.1182/blood-2017-10-804096.

19. Levi M., Thachil J., Iba T. et al. Coagulation abnormalities and thrombosis in patients with COVID-19 // Lancet Haematol. ‒ 2020. ‒ Vol. 7, № 6. ‒ P. e438– е440. doi: https://doi.org/10.1016/S2352-3026(20)30145-9.

20. Levi M., van der Poll T. Coagulation and sepsis // Thromb. Res. ‒ 2017. ‒ Vol. 149. ‒ P. 38–44. doi: 10.1016/j. thrombres. 2016.11. 007.

21. Liao S., Woulfe T., Hyder S. et al. Incidence of venous thromboembolism in different ethnic groups: a regional direct comparison study // J. Thromb. Haemost. ‒ 2014. ‒ Vol. 12, № 2. ‒ P. 214–219. doi: 10.1111/jth. 12464.

22. Libby P., Lüscher T. COVID-19 is, in the end, an endothelial disease // Eur. Heart. J. ‒ 2020. ‒ Vol. 21, № 41 (32). ‒ P. 3038–3044. https://doi. org/10.1093/eurheartj/ehaa623.

23. Lin H., Xu L., Yu S. et al. Therapeutics targeting the fibrinolytic system // Exp. Mol. Med. ‒ 2020. ‒ Vol. 52, № 3. ‒ P. 367–379. doi: 10.1038/s12276-020-0397-x.

24. Lim W., Le Gal G., Bates S.M., et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism // Blood Adv. ‒ 2018. ‒ Vol. 2, № 22. ‒ P. 3226–3256. doi: 10.1182/bloodadvances. 2018024828.

25. Lim W., Meade M., Lauzier F. et al. Failure of anticoagulant thromboprophylaxis: risk factors in medical-surgical critically ill patients // Crit. Care Med. ‒ 2015. ‒ Vol. 43, No 2. ‒ P. 401–410. doi: 10.1097/CCM. 0000000000000713.

26. Llitjos J.-F., Leclerc M., Chochois C. et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients // J. Thromb. Haemost. ‒ 2020. ‒ Vol. 18, № 7. ‒ P. 1743–1746. doi: 10.1111/jth. 14869.

27. Lodigiani C., Iapichino G., Carenzo L. et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy // Thromb. Res. ‒ 2020. ‒ Vol. 191. ‒ P. 9–14. doi: 10.1016/j. thromres. 2020. 04. 024.

28. Lowenstein C. J., Solomon S. D. Severe COVID-19 is a microvascular disease // Circulation. ‒ 2020. ‒ Vol. 142, № 17. ‒ Р. 1609–1611. doi: 10.1161 / CIRCULATIONAHA. 120. 050354.

29. Maatman T. K., Jalali F., Feizpour C. et al. Routine venous thromboembolism prophylaxis may be inadequate in the hypercoagulable state of severe coronavirus disease 2019 // Crit. Care Med. ‒ 2020. ‒ Vol. 48, № 9. ‒ P. e783– е790. doi: 10.1097/CCM. 0000000000004466.

30. Magro C., Mulvey J. J., Berlin D. et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases // Transl. Res. ‒ 2020. ‒ Vol. 220. ‒ P. 1–13. doi: 10.1016/j. trsl.2020.04.007.

31. Marshall R. P. The pulmonary renin-angiotensin system // Curr. Pharm. Des. ‒ 2003. ‒ Vol. 9, № 9. ‒ P. 715–722. DOI: 10.2174/1381612033455431.

32. Martín‐Rojas R. M., Pérez‐Rus G., Delgado‐Pinos V. E. et al. COVID-19 coagulopathy: An in-depth analysis of the coagulation system // Eur. J. Haematol. ‒ 2020. ‒ Vol. 105, № 6. ‒ P. 741–750. https://doi.org/10.1111/ejh.13501.

33. Mehta P., McAuley D. F., Brown M. et al. COVID-19: consider cytokine storm syndromes and immunosuppression // Lancet Lond. Engl. ‒ 2020. ‒ Vol. 28, № 395. ‒ P. 1033–1034. doi: 10.1016/S0140-6736(20) 30628-0.

34. Middeldorp S., Coppens M., van Haaps T. F. et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19 // J. Thromb. Haemost. ‒ 2020. ‒ Vol. 18, № 8. ‒ P. 1995–2002. doi: 10.1111 / jth. 14888.

35. Monteil V., Kwon H., Prado P. et al. Inhibition of SARS-CoV-2 infections in engineered human tissues using clinical-grade soluble human ACE2 // Cell. ‒ 2020. ‒ Vol. 181, № 4. ‒ P. 905-913. doi: 10.1016 / j. cell. 2020. 04.004.

36. Moores L. K., Tritschler T., Brosnahan S. et al. Prevention, diagnosis, and treatment of vte in patients with coronavirus disease 2019 // Chest. ‒ 2020. ‒ Vol. 158, № 3. ‒ P. 1143–1163. doi: 10.1016 / j. chest. 2020. 05.559.

37. Mortus J. R., Manek S. E., Brubaker L. S. et al. Thromboelastographic results and hypercoagulability syndrome in patients with coronavirus disease 2019 who are critically Ill // JAMA Netw Open [Internet]. 2020 Jun 5 [cited 2021 Jan 22]; 3 (6). Available from: https://www.ncbi.nlm.nih. gov/pmc/articles/PMC7275245/

38. Obi A. T., Barnes G. D., Napolitano L. M. et al. Venous thrombosis epidemiology, pathophysiology, and anticoagulant therapies and trials in severe acute respiratory syndrome coronavirus 2 infection // J. Vasc. Surg. Venous. Lymphat. Disord. ‒ 2021. ‒ Vol. 9, № 1. ‒ P. 23–35. doi: 10.1016/j. jvsv. 2020. 08.030.

39. Panigada M., Bottino N., Tagliabue P. et al. Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis // J. Thromb. Haemost. ‒ 2020. ‒ Vol. 18, № 7. ‒ P. 1738–1742. doi: 10.1111/jth.14850.

40. Piazza G., Morrow D. A. Diagnosis, management, and pathophysiology of arterial and venous thrombosis in COVID-19 // JAMA. ‒ 2020. ‒ Vol. 324, № 24. ‒ P. 2548–2549. doi:10.1001/jama. 2020.23422.

41. Poissy J., Goutay J., Caplan M. et al. Pulmonary embolism in patients with COVID-19: awareness of an increased prevalence // Circulation. ‒ 2020. ‒ Vol. 142, № 2. ‒ P. 184–186. https://doi.org/10.1161/CIRCULATIONAHA.120.047430.

42. Poterucha T. J., Libby P., Goldhaber S. Z. More than an anticoagulant: Do heparins have direct anti-inflammatory effects? // Thromb. Haemost. 2017. ‒ Vol. 117, № 3. ‒ P. 437–444. doi: 10.1160 / TH16-08-0620.

43. Raskob G. E., Angchaisuksiri P., Blanco A. N. et al. Thrombosis: a major contributor to global disease burden // Semin. Thromb. Hemost. ‒ 2014. ‒ Vol. 40, № 7. ‒ P. 724–735. doi: 10.1161 / ATVBAHA. 114. 304488.

44. Reininger A. J. The function of ultra-large von Willebrand factor multimers in high shear flow controlled by ADAMTS13 // Hamostaseologie. ‒ 2015. ‒ Vol. 35, № 3. ‒ P. 225–233. doi: 10.5482/HAMO-14-12-0077.

45. Salem N., Atallah B., El Nekidy W. S. et al. Thromboelastography findings in critically ill COVID-19 patients // J. Thromb. Thrombolysis. ‒ 2020. ‒ Vol. 4. ‒ P. 1–5. doi: 10.1007/s11239-020-02300-7.

46. Schwameis M., Schörgenhofer C., Assinger A. et al. VWF excess and ADAMTS13 deficiency: a unifying pathomechanism linking inflammation to thrombosis in DIC, malaria, and TTP // Thromb. Haemost. ‒ 2015. ‒ Vol. 113, № 4. ‒ P. 708–718. doi: 10.1160 / TH14-09-0731.

47. Spyropoulos A. C., Levy J. H., Ageno W. et al. Scientific and Standardization Committee communication: Clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19 // J. Thromb. Haemost. ‒ 2020. ‒ Vol. 8. ‒ P. 1859–1865. https://doi. org/10.1111/jth.14929.

48. Stern D., Nawroth P., Handley D. et al. An endothelial cell-dependent pathway of coagulation // Proc. Natl. Acad. Sci. ‒ 1985. ‒ Vol. 82, № 8. ‒ P. 2523–2527. doi: 10.1073 / pnas. 82. 8.2523.

49. Stirling D., Hannant W. A., Ludlam C. A. Transcriptional activation of the factor VIII gene in liver cell lines by interleukin-6 // Thromb. Haemost. ‒ 1998. ‒ Vol. 79, № 1. ‒ P. 74–78. PMID: 9459327.

50. Stouthard J. M., Levi M., Hack C. E. et al. Interleukin-6 stimulates coagulation, not fibrinolysis, in humans // Thromb. Haemost. 1996. ‒ Vol. 76, № 5. ‒ P. 738–742. PMID: 8950783.

51. Tang N., Bai H., Chen X. et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy // J. Thromb. Haemost. ‒ 2020. ‒ Vol. 18, № 5. ‒ P. 1094–1099. doi: 10.1111/jth.14817.

52. Tang N., Li D., Wang X. et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia // J. Thromb. Haemost. ‒ 2020. ‒ Vol. 18, No 4. ‒ P. 844–847. DOI: 10.1111/jth.14768.

53. Tavazzi G., Civardi L., Caneva L. et al. Thrombotic events in SARS-CoV-2 patients: an urgent call for ultrasound screening // Intens. Care Med. ‒ 2020. ‒ Vol. 46, No 6. ‒ P. 1121–1123. doi: 10.1007/s00134-020-06040-3.

54. Thachil J., Tang N., Gando S. et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19 // J. Thromb. Haemost. ‒ 2020. ‒ Vol. 18, № 5. ‒ P. 1023–1026. doi: 10.1111/JTH.14810.

55. Trigonis R. A., Holt D. B., Yuan R. et al. Incidence of venous thromboembolism in critically ill coronavirus disease 2019 Patients Receiving Prophylactic Anticoagulation // Crit Care Med. ‒ 2020. ‒ Vol. 48, № 9. ‒ P. e805–808. doi: 10.1097/CCM. 0000000000004472.

56. Tu W.-J., Cao J., Yu L. et al. Clinicolaboratory study of 25 fatal cases of COVID-19 in Wuhan // Intens. Care Med. ‒ 2020. ‒ Vol. 46, № 6. ‒ P. 1117–1120. doi: 10.1007/s00134-020-06023-4.

57. Vaughan D. E. Angiotensin, fibrinolysis, and vascular homeostasis // Am. J. Cardiol. ‒ 2001. ‒ Vol. 87, № 8A. ‒ P. 18C‒24C. DOI: 10.1016/s0002-9149 (01)01509-0.

58. Varga Z., Flammer A. J., Steiger P. et al. Endothelial cell infection and endotheliitis in COVID-19 // Lancet Lond. Engl. ‒ 2020. ‒ Vol. 395 (10234). ‒ P. 1417–1418. doi: 10.1016/S0140-6736(20)30937-5.

59. Wada H., Matsumoto T., Suzuki K. et al. Differences and similarities between disseminated intravascular coagulation and thrombotic microangiopathy // Thromb. J. ‒ 2018. ‒ Vol. 16, № 1. ‒ P. 14. doi: 10.1186/s12959-018-0168-2.

60. White R. H., Keenan C. R. Effects of race and ethnicity on the incidence of venous thromboembolism // Thromb. Res. ‒ 2009. ‒ Vol. 123, Suppl. 4. ‒ S11‒S17. doi: 10.1016/S0049-3848(09) 70136-7.

61. Yuriditsky E., Horowitz J. M., Merchan C. et al. Thromboelastography profiles of critically ill patients with coronavirus disease 2019. crit care med [Internet]. ‒ 2020 Jun 30 [cited 2021 Jan 22]; Available from: https://www.ncbi.nlm.nih. gov/pmc/articles/PMC7314320/

62. Zhang W., Zhao Y., Zhang F. et al. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from China // Clin. Immunol. Orlando Fla. ‒ 2020. ‒ Vol. 214. ‒ P. 108393. doi: 10.1016/j. clim. 2020.108393.


Для цитирования:


Лаврентьева А., Тсотсолис С. Тромбоэмболические осложнения при заболевании COVID-19, коротко об изменениях в рекомендациях. Вестник анестезиологии и реаниматологии. 2021;18(1):37-46. https://doi.org/10.21292/2078-5658-2021-18-1-37-46

For citation:


Lavrentieva А., Tsotsolis S. Thromboembolic complications in COVID-19 disease, a brief update. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2021;18(1):37-46. (In Russ.) https://doi.org/10.21292/2078-5658-2021-18-1-37-46

Просмотров: 788


Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.


ISSN 2078-5658 (Print)
ISSN 2541-8653 (Online)