Tom 15, Nr 3 (2022)
Artykuł przeglądowy
Opublikowany online: 2022-09-28
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Żylna choroba zakrzepowo-zatorowa i leczenie przeciwzakrzepowe w COVID-19
Journal of Transfusion Medicine 2022;15(3):266-271.
Streszczenie
Szczególną cechą COVID-19, głównie o ciężkim przebiegu, jest zwiększona skłonność do występowania
epizodów żylnej choroby zakrzepowo-zatorowej (ŻChZZ). Dość często przybiera
ona postać izolowanej zatorowości płucnej i bywa przyczyną nagłego zgonu chorych. Epizody
ŻChZZ obserwowano pomimo standardowej profilaktyki przeciwzakrzepowej, dlatego zasadnicze
znaczenie w przebiegu COVCID-19 ma dobór właściwej dawki leków stosowanych w profilaktyce
i leczeniu ŻChZZ. Lekami z wyboru są heparyny drobnocząsteczkowe (HDCz). W wielu
randomizowanych badaniach klinicznych porównywano dawki profilaktyczne, pośrednie i lecznicze
HDCz stosowane w profilaktyce ŻChZZ u chorych, zależnie od ciężkości przebiegu choroby.
Niniejsze opracowanie przedstawia bieżące zalecenia grupy ekspertów International Society
on Thrombosis and Hememostasis na temat profilaktyki ŻChZZ w przebiegu COVID-19, które
powstały na podstawie wyników dostępnych obecnie badań klinicznych.
Słowa kluczowe: żylna choroba zakrzepowo-zatorowaCOVID-19leczenie przeciwzakrzepoweprofilaktyka przeciwzakrzepowaheparynyDOAC
Referencje
- Lippi G, Favaloro EJ. D-dimer is Associated with Severity of Coronavirus Disease 2019: A Pooled Analysis. Thromb Haemost. 2020; 120(5): 876–878.
- Brzezinski LC, Houston S, Thachil J, et al. D-dimers: a most misunderstood test. Brit J Hosp Med. 2021; 82: 1–5.
- Kaptein FHJ, Stals MAM, Grootenboers M, et al. Dutch COVID & Thrombosis Coalition, Dutch COVID & Thrombosis Coalition. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020; 191: 145–147.
- Middelsdorp S, Coppens M, van Ha, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020; 18: 1995–2002.
- Tan BK, Mainbourg S, Friggeri A, et al. Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis. Thorax. 2021; 76(10): 970–979.
- Giannis D, Allen SL, Tsang J, et al. Postdischarge thromboembolic outcomes and mortality of hospitalized patients with COVID-19: the CORE-19 registry. Blood. 2021; 137(20): 2838–2847.
- Gu SX, Tyagi T, Jain K, et al. Thrombocytopathy and endotheliopathy: crucial contributors to COVID-19 thromboinflammation. Nat Rev Cardiol. 2021; 18(3): 194–209.
- Spyropoulos AC, Levy JH, Ageno W, et al. Subcommittee on Perioperative, Critical Care Thrombosis, Haemostasis of the Scientific, Standardization Committee of the International Society on Thrombosis and Haemostasis. 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; 18(8): 1859–1865.
- Liverpool Drug Interaction Group. Interactions with experimental COVID-19 therapies. https://www.covid19-druginteractions.org/.
- Bikdeli B, Madhavan MV, Jimenez D, et al. Global COVID-19 Thrombosis Collaborative Group, Endorsed by the ISTH, NATF, ESVM, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020; 75(23): 2950–2973.
- REMAP-CAP In4, Goligher EC, Bradbury CA, et al. Therapeutic anticoagulation with heparin in critically ill patients with COVID-19. N Engl J Med. 2021; 385: 777–789.
- Lawler PR, Goligher EC, Berger JS, et al. ATTACC Investigators, ACTIV-4a Investigators, REMAP-CAP Investigators. Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19. N Engl J Med. 2021; 385(9): 790–802.
- Lopes R, Silva Pd, Furtado R, et al. Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicentre, randomised, controlled trial. The Lancet. 2021; 397(10291): 2253–2263.
- Spyropoulos AC, Goldin M, Giannis D, et al. HEP-COVID Investigators. Efficacy and Safety of Therapeutic-Dose Heparin vs Standard Prophylactic or Intermediate-Dose Heparins for Thromboprophylaxis in High-risk Hospitalized Patients With COVID-19: The HEP-COVID Randomized Clinical Trial. JAMA Intern Med. 2021; 181(12): 1612–1620.
- Sholzberg M, Tang GH, Rahhal H, et al. RAPID trial investigators. Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial. BMJ. 2021; 375: n2400.
- Lemos AC, do Espírito Santo DA, Salvetti MC, et al. Therapeutic versus prophylactic anticoagulation for severe COVID-19: A randomized phase II clinical trial (HESACOVID). Thromb Res. 2020; 196: 359–366.
- Marcos-Jubilar M, Carmona-Torre F, Vidal R, et al. Therapeutic versus Prophylactic Bemiparin in Hospitalized Patients with Nonsevere COVID-19 Pneumonia (BEMICOP Study): An Open-Label, Multicenter, Randomized, Controlled Trial. Thrombosis and Haemostasis. 2021; 122(02): 295–299.
- Brooks M, Sciurba F, Krishnan J, et al. Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19. JAMA. 2021; 326(17): 1703.
- Gonzalez-Ochoa AJ, Raffetto JD, Hernández AG, et al. Sulodexide in the Treatment of Patients with Early Stages of COVID-19: A Randomized Controlled Trial. Thromb Haemost. 2021; 121(7): 944–954.
- RECOVERY Investigators. Aspirin in patients admitted to hospital with COVID-19 (RECOVERY): a randomized, controlled, open-label, platform trial. Lancet. 2022; 399: 143–151.
- Bradbury CA, Lawler PR, Stanworth SJ, et al. Effect of antiplatelet therapy on survival and organ-support free days in critically ill patients with COVID-19: a randomized clinical trial. JAMA. 2022; 327: 1247–1259.
- Ramacciotti E, Barile Agati L, Calderaro D, et al. MICHELLE investigators. Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalisation for COVID-19 (MICHELLE): an open-label, multicentre, randomised, controlled trial. Lancet. 2022; 399(10319): 50–59.
- Schulman S, Sholzberg M, Spyropoulos AC, et al. International Society on Thrombosis and Haemostasis. ISTH guidelines for antithrombotic treatment in COVID-19. J Thromb Haemost. 2022; 20(10): 2214–2225.
- Hozayen SM, Zychowski D, Benson S, et al. Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients. EClinicalMedicine. 2021; 41: 101139.
- Spyropoulos AC, Connors JM, Douketis JD, et al. International Society on Thrombosis and Haemostasis. Good practice statements for antithrombotic therapy in the management of COVID-19: Guidance from the SSC of the ISTH. J Thromb Haemost. 2022; 20(10): 2226–2236.
- Spyropoulos AC, Ageno W, Albers GW, et al. Post-Discharge Prophylaxis With Rivaroxaban Reduces Fatal and Major Thromboembolic Events in Medically Ill Patients. J Am Coll Cardiol. 2020; 75(25): 3140–3147.
- Loffredo L, Di Castelnuovo A, Chiariello GA, et al. Full prophylactic-intermediate doses of anticoagulants in COVID-19: a meta-analysis. Haematologica. 2022; 107(8): 1933–1939.
